About a year ago both Kyle and I were involved in bone-shattering climbing accidents that changed the way we view the world and ultimately became the spark for the creation of this podcast. In our earlier episodes, we spent time discussing our accidents, recovery processes, and the psychological effects traumatic injuries have on the mind. Having now recovered to a point where we both are participating in climbing and living a pseudo-normal life we felt it was time to talk with some professionals. In this episode, we talk with physical therapists Matthew and Kevin about the bio, psycho, social model of patient care, specific return to sport measures, climbing strain injuries, proper warm-up protocol for injury prevention, and much more.
Please review us wherever you listen to this podcast.
Have a question?
DM us on IG: @the.climbing.majority
About a year ago both Kyle and I were involved in bone-shattering climbing accidents that changed the way we view the world and ultimately became the spark for the creation of this podcast. In our earlier episodes, we spent time discussing our accidents, recovery processes, and the psychological effects traumatic injuries have on the mind. Having now recovered to a point where we both are participating in climbing and living a pseudo-normal life we felt it was time to talk with some professionals. In this episode, we talk with physical therapists Matthew and Kevin about the bio, psycho, social model of patient care, specific return to sport measures, climbing strain injuries, proper warm-up protocol for injury prevention, and much more.
Please review us wherever you listen to this podcast.
Have a question?
DM us on IG: @the.climbing.majority
00:00:01:09 - 00:00:10:03
Speaker 1
Hello everyone and welcome to the Climbing Majority podcast, Max Carrier here, one of the co-hosts. Quick message before we dove into the episode.
00:00:10:17 - 00:00:11:11
Speaker 2
If you've been enjoying.
00:00:11:11 - 00:00:15:01
Speaker 1
The show, please rate and review us on Apple and Spotify.
00:00:15:10 - 00:00:16:15
Speaker 3
Also consider sharing.
00:00:16:15 - 00:00:29:12
Speaker 1
This podcast with your climbing friends. Word of mouth is a powerful tool to help us out with that housekeeping out of the way. We can get into today's episode in today's conversation. Kyle and I have a conversation with.
00:00:29:23 - 00:00:30:17
Speaker 3
Kevin, right.
00:00:30:17 - 00:00:32:02
Speaker 1
And Matthew Horovitz.
00:00:32:07 - 00:00:33:17
Speaker 2
They are both occupational.
00:00:33:17 - 00:00:34:07
Speaker 3
Therapists.
00:00:34:07 - 00:00:36:07
Speaker 1
That reside in Reno, Nevada.
00:00:36:14 - 00:00:38:05
Speaker 3
The topics that we cover include.
00:00:38:12 - 00:00:39:19
Speaker 1
Rehabilitation.
00:00:39:19 - 00:00:40:21
Speaker 2
Injury prevention.
00:00:41:08 - 00:00:58:14
Speaker 1
Strength training, muscular imbalances and much more.
00:01:01:16 - 00:01:22:22
Speaker 1
Wicked bad, yo. You know, speaking for myself, Mike, pretty, pretty stoked to have you guys here and, you know, ready to have a nice, good conversation and stuff. And, you know, Jeremy, for us, I think a good way to go about this is to just, you know, give yourself kind of a brief introduction of, you know, like who you are, where you're from, and maybe some of your credentials and, you know.
00:01:22:22 - 00:01:44:06
Speaker 1
Yeah. And then you go from there. Yeah, sure. All right. So, yeah, I've been a PE teacher about nine years. I graduated up in Spokane, Washington, where I've been working for the last little bit and mostly got into for sports oriented stuff, you know, grew up an athlete my whole life, played all sports under the sun, but mostly, mostly focused on basketball, have really done a whole lot of climbing.
00:01:45:06 - 00:02:03:22
Speaker 1
But I've treated a handful of climbers because where I work in Spokane, we actually helped run kind of a strength and conditioning gym that also had physical therapy and alcohol training in it. But across the street was a climbing, so we got a lot of patients from there. You guys were good for business?
00:02:04:15 - 00:02:04:22
Speaker 2
Yes.
00:02:05:08 - 00:02:20:23
Speaker 1
Which was it was a good way to get involved, you know, like getting a good experience to know what types of injuries climbers sustain, where some of the terminology, some of the techniques, some of the goals of getting back into it and stuff. And it was really fun because it was it was we could just go across the street.
00:02:21:13 - 00:02:52:14
Speaker 1
They can clock into their session. We go across the street and climb, you know, we're going to see some stuff later about how good climbing is for low back pain and low back injury. So we really kind of used that as an excuse to go over there and have fun for 45 minutes or an hour. So yeah, so about nine months ago or so moved down to Reno where I am now, and accepted a job for Northern Nevada rehab, rehabbing, sports, medicine, and then kind of working there for the last little bit and starting to develop kind of the sports medicine niche.
00:02:52:15 - 00:02:59:05
Speaker 1
You know, some doctors in town get some referrals from different clubs for and stuff like that and just enjoying it.
00:03:00:05 - 00:03:10:22
Speaker 4
Hey, Kevin, I just have a quick question. When you when you went over to the climbing gym, did you ever do a treatment like a do like a pre and post test to see the value of the treatment that you provided?
00:03:11:14 - 00:03:29:03
Speaker 1
Yeah, it was really interesting. You know, like in the past world, we had this thing called Astroturf signs, which is you do something that normally hurts the person, right? Like not doesn't hurt to cause some pain. Right? So I say some of the back pain. You have reached out. Touch the post. Yeah. You know it kind of cause some point of pain on my back and you know, you put a number on it or whatever.
00:03:29:03 - 00:03:58:17
Speaker 1
And then the idea behind an aspect is and you do some techniques, whether it's therapy, hands on stuff, some exercise stretching, and then you have to redo that movement and see if they feel better or worse, the same. That really kind of dictates your path of treatment. So yeah, specifically for vaccine, I would go over there and I mean, let me see a, you know, extend and rotate, you know, if that kind of hurts, let's go for a good 5 minutes on the wall and get the muscles firing and then come back down and out every time.
00:03:58:17 - 00:04:14:04
Speaker 1
But a lot of times to do that same, it's going to rotate and move that first place and feel better. So it's really pretty fascinating to see some of that research have been done about how climbing can treat low back pain. And I could see it from your eyes, so it's pretty cool.
00:04:14:04 - 00:04:37:00
Speaker 4
Yeah, I don't want to jump ahead or anything, but the one thing to emphasize kind of going forward is when we talk about diagnosis and specifically pathway to atomic diagnosis, you're like, oh, that hurts there. You know, the pain is associated with this structure is actually quite unreliable in across all disciplines physicians, physical therapists, chiropractic, you name it.
00:04:37:06 - 00:05:12:00
Speaker 4
We are very poor at that as a discipline. And that's not like providers specific. So it's always interesting for us as a profession and very powerful to have something that was bothersome, do an intervention and then see that same action resolved through a variety of reasons, some of which are placebo, some of which are unknown to us. But it is still a really powerful in like injure or in treatment kind of a sign that we're doing the right thing.
00:05:12:15 - 00:05:19:02
Speaker 1
Yeah, that's fun to see. It's fun to see the eyes kind of light up. Do you know where they said, whoa, what? What? What did you just do?
00:05:19:05 - 00:05:21:00
Speaker 2
You know?
00:05:21:00 - 00:05:31:11
Speaker 1
And sometimes sometimes it's as simple as we took the threat away, you know, we made that move it not scary anymore, you know. And sometimes we actually aren't seeing in the tissue. But yeah, kind of just depends.
00:05:32:05 - 00:05:44:20
Speaker 3
How much how much of your work would you say is mental and how much of your work would you say is physical in terms of your effect on the person you're working on? Is that does that question make sense?
00:05:45:20 - 00:05:46:02
Speaker 2
Yeah.
00:05:46:16 - 00:05:48:01
Speaker 1
You want to take it out? Do you want me to take it?
00:05:48:08 - 00:06:14:01
Speaker 4
Yeah. So I can sort of, you know, I'll enjoy that question in second. I can introduce myself. I'm Matthew Ravitz. I, too, am a physical therapist. I've been practicing a little bit longer than Kevin about 13 years now. I've been sort of doing my own conscious private practice for the last six years, and then I do like basically home health, which is sort of geriatric care, but that one pays the bills.
00:06:14:09 - 00:06:38:18
Speaker 4
The private practice kind of feeds my mind is how I, how I kind of shape my work experience. I think the differentiating factor for Kevin and I is our fellowship training. And this fellowship training is a big part of sort of the fun in physical therapy. It's two and a half years graduate work and you get to work with mentors and then you get introduced to this community of fellows.
00:06:38:18 - 00:07:03:08
Speaker 4
And that's actually how Kevin and I met. He reached out to me and one of my mentors and then put us in touch. And now I've been lucky enough for some of the patients I can treat. I've been able to triage them right into Kevin's practice since it's insurance based, and it's been a wonderful experience. You know, my relationship with climbing, who we go into this is, you know, I'm pretty active outdoorsmen, similar probably to both you, Max and Kyle.
00:07:03:23 - 00:07:41:22
Speaker 4
I started off as a backcountry steer and then did a bunch of sort of ski mountaineering in the area, northern Nevada and sort of California, known for the volcano seasons. So we have not lost it. And Shasta, nearby and kind of climbing was just a sort of progression from those like basic mountaineering skills kind of my interests are sort of these long moderates that the Sierras and known for comfortable five six track lead kind of scrambling low class this put prefer ropes and I mostly do outdoor climbing at this point hardly any gym climbing.
00:07:41:22 - 00:08:03:08
Speaker 4
And you know as I said before, sport climbing is a little too hard for me for my kind of activity standpoint, but so that's my intro. Kyle, with respect to your question, I can jump on that first. I think it's a good mix and there's something that we work with is called the bio psychosocial model, which I don't know.
00:08:03:10 - 00:08:29:21
Speaker 4
Have you guys heard of that? I have, Max. Yeah. So, I mean, it's just sort of that intersection of all three of those, you know, the biology of the problem, the sort of social aspects, self esteem, family, blah, blah, blah, and then the psycho psych psychological aspects of that, you know, how do you approach a problem? Like how do you see danger in all of those things?
00:08:29:21 - 00:09:04:01
Speaker 4
So when we talk about treatment, I kind of think of it in a way that, you know, you have a number of hypotheses, right? So you have what's the problem is one hypothesis, sort of what's the pain generation? There's another hypothesis who the patient is, what are their beliefs, and then what are their goals? And as you kind of go through your hypotheses generation and then intervention choice, you have to slide each one of those kind of aspects up a little bit and then down a little bit and then up a little bit and down a little bit as you go through it.
00:09:05:02 - 00:09:28:17
Speaker 4
So I mean, it's hard to put a percentage on it, but I think it's more sort of patients, the Civic and that kind of gets into sort of repetition like you can assume a patient sort of or make assumptions on a patient just based on their interview. And that subjective interview is probably one of the more powerful determinants in regards to deciding what your intervention strategy is.
00:09:28:17 - 00:09:37:15
Speaker 4
Is it more exercise based? Is it more manual therapy based? Is it this sort of bio psychosocial aspect to it? I don't know, Kevin, if you want to add to that.
00:09:38:23 - 00:09:55:23
Speaker 1
Yeah, I agree with all of that. I think another another part that I really wanted to focus on over the last couple of years is really trying to get the hang of whoever is in front of this personality, you know, and if they are a type of person who sees an injury as just a bump in the road, they'll be fine.
00:09:55:23 - 00:10:12:16
Speaker 1
They'll get back to it. No big deal. You know, they know they heal. They know they're going to get better versus the person who kind of catastrophize a little bit. You know, they feel like their injury has taken over their lives and they have a hard time. They don't see themselves able to get back. And, you know, you're going to treat those two people a lot different.
00:10:12:19 - 00:10:36:08
Speaker 1
You know, I've really learned to become almost like a psychotherapist at times over a physical therapist. You know, sometimes people just need a lot of reassurance, you know, reassurance. They they don't think they're ever going to be able to get back to it. And, you know, we know that people have different just anatomic nervous systems where, you know, the pain signal comes in the spinal cord up to the brain.
00:10:36:17 - 00:11:02:10
Speaker 1
And we all have connections from our sensory part of the brain to our emotional part of the brain. Right. But some people have more connections, right? So they just have an exaggerated emotional response to an injury. Right? You're going to treat that person with a lot more of a slow kind of progression and a lot of reassurance and kind of pat them along the way and celebrate in small victories and things and and so to answer your questions, it's kind of a fascinating mix.
00:11:02:10 - 00:11:10:02
Speaker 1
You know, that the people that are go getters, you can just push them and just go crazy and kind of be blunt with them. The other people, you take a little more of a delicate.
00:11:10:02 - 00:11:28:17
Speaker 4
Yeah, as I say, from a climbing standpoint, in an analogy I like to use as your sort of exposure. So, you know, for me personally, like I'm not that comfortable at heights when I walk right up to them. So if I start at the top and walk to a cliff, I get an autonomic response, sort of like the butterflies.
00:11:28:17 - 00:11:53:21
Speaker 4
I get nervous, like I'll get like sort of sweating where I shouldn't be. But if I were to climb up from the bottom of that same cliff and get comfortable with that exposure to I don't have that autonomic response. And you'll find patients who come in and they're already having this sort of autonomic reaction that primes them for sort of they call it Aladin and Hyperalgesia.
00:11:54:05 - 00:12:07:08
Speaker 4
And so Aladin is typically your normal response to pain versus Hyperalgesia as it's elevated response to pain. And you can get a sense of those things that kind of speak to Kevin Kevin's. Kevin Nice point.
00:12:07:18 - 00:12:33:03
Speaker 1
I think that's such an interesting point you were talking about with like the bias psychosocial model because you know, I think Kyle and I have talked about this before where particularly to traumatic injuries, but I think this applies to like all walks of life and people in this kind of genre is that it's really easy to just myopically focus on like the actual trauma or the injury or the pain and really exclude that kind of like psychological or even that like social aspect, right?
00:12:33:03 - 00:12:58:15
Speaker 1
So it's like it's so catered towards, okay, we're going to focus on the biological, what you know, the psychological like you were just talking about. I don't exactly know that the terminology use, but you know, the psychological could be amplifying the pain based on your like your your response rate that can be affecting your healing process, your injury, the social component to the model, who's in your support group, what is your diet, what is your nutrition like?
00:12:58:15 - 00:13:24:18
Speaker 1
What are the influences around you like? How committed are you to this? There's so many things that go into therapy and rehabilitation and training that I feel like, or at least from my perspective, I feel generally when I talk to people who are really overlooked and I think a really common one that I've run into over the years with people is like, you know, they'll be like, Oh, I went to physio and you know, I didn't really it's not where they working for me or this or that.
00:13:24:18 - 00:13:44:19
Speaker 1
And then I'll be like, okay, well like how many days a week are you on a foam roller? How many days when you use a lacrosse ball? Like, how many days are you doing the prescribed exercises? You know, you can keep going down the list and usually, usually that in my experience valuable I won't beat other people with the same brush for my experience is people who are going through that.
00:13:45:09 - 00:13:59:13
Speaker 1
There's not a general level of consistency. So I'm wondering how do you guys you are talking about juggling those puzzle pieces in the beginning, right? And so to me, one of those puzzle pieces would definitely be on a psychological level, gauging like.
00:14:00:14 - 00:14:01:05
Speaker 3
How.
00:14:01:06 - 00:14:21:22
Speaker 1
How committed is this person? Like, how much of what I'm saying right now is actually going to be followed through on? And so I'm wondering how you guys how you guys deal with that with your clients. I you know, it's kind of funny because you would you would imagine the more high level athletic person is going to want to work the hardest is not always the case.
00:14:21:22 - 00:14:42:09
Speaker 1
Right? Sometimes these guys are just coasted on their ability or gals tilted on their ability and don't really have the work ethic or the the mindset to really work hard at, you know, recovery. So, no, I think you can get Dana watch and talking to somebody just from taking your subjective history with these people, you know, and you can get an idea of, you know, they'll help you.
00:14:42:11 - 00:15:02:11
Speaker 1
You know, you'll get a vibe from it and they'll tell you, like, I'm here to work, you know, like, I know it's going to take a while or you get the other people I was talking about earlier where they're a little nervous and a little scared that they're kind of amplifying maybe a little bit. You know, when pain is such a subjective thing, you don't really know exactly, you know, what they're feeling.
00:15:02:23 - 00:15:20:02
Speaker 1
But yeah, I mean, it's, it's, it's definitely takes a little getting used to and takes some experience as a provider to kind of be able to pick up on people's personalities. And I've also gotten a little bit more blunt with people, you know, like, like, look, you're not doing your stuff. Like if you want to get better, you have this.
00:15:20:02 - 00:15:32:13
Speaker 1
This isn't my knee, you know, like this is my shoulder. I'm not going to babysit you, you know, and and try to check in all the time. Like you have to have some accountability. And sometimes that gets people, you know, if people kind of tuned into what needs to happen, it's motivated.
00:15:33:09 - 00:15:36:09
Speaker 3
It's easy not to do anything and to blame the tip for your problems.
00:15:36:12 - 00:15:38:05
Speaker 4
Yeah. Yeah. I mean.
00:15:38:14 - 00:15:40:03
Speaker 1
We get it from patients and doctors.
00:15:40:10 - 00:16:05:06
Speaker 4
There's a bit of accountability that I sort of prescribe, too. So statistically speaking, people are compliant with between three and five exercises. So, you know, in that that's like the kind of sweet spot that you want to aim for in order to get more compliance, you know. And then sort of the other thing is Kevin and I have a strong background in manual therapy.
00:16:05:14 - 00:16:33:15
Speaker 4
And when you think of physical therapy, a lot of people associate that with like hands on things. And frankly, everybody loves to get hands on treatment. Right? It feels good. You can get immediate results. You can resolve some of the acute issues really, really quickly. With that said, that has with the evidence sort of been shown to have a short impact where exercise is ultimately going to be the long impact.
00:16:34:05 - 00:16:58:19
Speaker 4
And when I'm encountered with somebody who I think is somewhat noncompliant with their exercises and slowing down sort of their overall recovery, I'll take away the manual therapy component in their treatment and just go through their exercises. Right. And that will reinforce the value of the exercise. And then I will use the manual therapy as sort of like this, like the treat at the end, right.
00:16:58:19 - 00:17:19:00
Speaker 4
Versus kind of starting off with like what feels good and they're like, Oh, it's really valuable. I get value out of this, but that's how I would do it. And then I do tell patients this a lot is that I'll shoulder the responsibility because at some level if everybody is failing the test, it's the teacher's fault, it's not the student's fault.
00:17:19:09 - 00:17:38:20
Speaker 4
And so I'll sort of bring them along that journey and along this sort of biased, psychosocial aspect. I don't want to get too bogged down in it because it goes a little bit beyond. And I always try to remind people there is a physical before the therapy, because sometimes people want to talk a lot and you just have to sort of work your way through that.
00:17:38:20 - 00:18:10:02
Speaker 4
But sort of no, no, I kind of losing my train of thought, but sort of it's an alliance. And so what has to happen is that the patient themselves has to feel like you're on their side and you're going to journey with them through it. And I think when you guys kind of talked about all of this acute injury stuff that you've gone through and all the surgical consults and the surgery themselves, kind of like you know, when the surgeon is done and this is no criticism, they're like, hooray, I did a great job.
00:18:10:15 - 00:18:32:22
Speaker 4
And then they just like, You're out the door, you go see your therapist, so you need someone to sort of shepherd you through this and they discover is like a therapeutic alliance. And if you if you sort of subscribe to that alliance with your patients, you're going to get a lot more compliance. And so that's where that's sort of where I come from in my thought process.
00:18:33:08 - 00:18:48:01
Speaker 1
I think that's that's a really interesting terminology use, which is a therapeutic alliance. Right. I know for myself like there is a physiotherapist, Mitch is this gentleman who works at like Gleneagles physiotherapy by where I live and he he mainly focuses on.
00:18:48:01 - 00:18:48:15
Speaker 3
Iams.
00:18:49:10 - 00:19:11:06
Speaker 1
And for me that was perfect because I have like a large background down in doing my own kind of exercise, my own work. I have a history of injuries, so I was less focused on that. I was already, if anything, doing too much of that. So I needed the more actual like active physical therapy from the therapist and as well like I have a really good relationship with him.
00:19:11:06 - 00:19:32:13
Speaker 1
Like he's a really kind individual. I would talk about him, I would always check in with how I was doing. And so there is this really big component of like like this therapy component of almost going in there and like feeling supported by him. So it was like beyond just getting like physical and manual therapy, it was like as a team together trying to tackle a problem.
00:19:32:13 - 00:19:40:04
Speaker 1
And I know for myself that that that was a really beneficial thing and something that had a big impact on my life. So I just think that's a really interesting point that you're pointing out there.
00:19:40:18 - 00:20:02:05
Speaker 4
Yeah. Yeah. So Mitch has done a great job, whether you put a name to it or not. And, you know, I can talk a little bit about and Kyle, you can chime in here about our relationship. Since I treated Kyle. And I think for me, living that therapeutic alliance with Kyle was he was honestly surprised when I said, I'll check in with you in eight weeks.
00:20:02:05 - 00:20:17:02
Speaker 4
And, you know, like I was on the dot eight weeks later or six weeks later or something like that, I reached out to him immediately. I mean, I had it on my calendar, but that's like, you know, Kyle didn't need a lot from me, but that was part of the journey that we had together.
00:20:19:00 - 00:20:43:10
Speaker 3
Yeah, I guess this kind of brings me to one of my questions. I think that we talked, you know, we talked about the, the the mental part of it. I'm interested in, in the education part of it. Like how, how, what percentage of, of people come into an injury and come into this kind of situation with a lack of body awareness, a lack of motor mechanics, a lack of understanding of even what is happening to them in the first place.
00:20:43:18 - 00:21:12:03
Speaker 3
And how do you or maybe they're convinced of one thing, but it's actually the other. You know, they're misinformed. How do you guys judge, judge that kind of understanding of of someone's own body? Yeah. And like with Martin, I like I've been a coach, I've been an athlete my entire life. I understand my body really well. And so, like, like you said, our relationship was much more there's just like, all right, what do I need to do?
00:21:12:08 - 00:21:36:18
Speaker 3
Here's my time frame I'm going to reach back to in eight weeks. It's like, all right, I got it. Like, I understand kind of the situation that I'm in and what I need to do as a much less hands on. But yeah, I think that for if I were in your shoes, I think the biggest, the biggest issue I would see is just kind of like trying to get that education piece across and getting people to understand mechanically what is exactly going on and how they need to connect with the injury.
00:21:38:03 - 00:21:54:19
Speaker 1
Yeah, people, I mean, when people walk in the door, you just have no idea to start with their level of understanding of how this is going to go. You know that like you said, their body awareness, have they been injured before? They know what it's going to take, how long it's going to take, that kind of stuff. So again, that subjective exam is huge.
00:21:54:19 - 00:22:15:15
Speaker 1
You get an idea and then towards the end, I mean, every single session I try to end with a piece of education know starts with that initial evaluation. You're trying to explain to them, hey, what's going on, b, how long it's going to take or we think it's going to take. Everyone's a little different with that, but and then see what to expect along the way, you know, like know that there's going to be some flare ups, know that it's not going to be a straight line, you know, just kind of reassure them.
00:22:15:21 - 00:22:35:10
Speaker 1
And again, this comes back to people's personalities. Some people we got to spend a lot more time. And one thing that we've gotten to as a profession that I think is very helpful is when we come when you start educating people, I don't know if you guys have seen these spine models before, but there are often these spine models with these giant red herniated disk on the back, right?
00:22:35:12 - 00:22:49:18
Speaker 1
And we used to sit there and take those things. But this is your back seat, this giant red thing. It's poking out the back of your back. And it's this snake venom that's irritating your nerve and causing your leg that go numb and be on fire, you know, and and that what does that you know, that just freaks them out, right?
00:22:49:18 - 00:23:05:15
Speaker 1
They think I have something blow up in my back and my legs on fire, but it it all, you know. So we've really shifted that even if we suspect something like that's going on, we don't really we don't bring up this giant model. You know, these injuries happen. You know, they can get better on their own due to some of these procedures.
00:23:05:15 - 00:23:18:02
Speaker 1
But we've got to give it a good shot first. And I think they really like that approach. I think that helps a lot in the long term as far as, you know, keeping them engaged and not scared.
00:23:19:09 - 00:23:46:17
Speaker 3
That's super interesting. I think that you that that point if like it's almost a difference between like a person coming to a doctor and being like, what's wrong with me? And they're just like, you're fucked. You've got a dirty Henry herniated disc in your legs going to, you know, going to be messed up, you know, it's like it's just so cut and dry and your job is almost this middleman to kind of, like, fluff it a little bit and like, you know, how serious the situation is that your job is kind of like it's not about telling them how seriously messed up they are.
00:23:46:18 - 00:23:58:07
Speaker 3
It's about giving them a path forward. And and sometimes ignorance is ignorance is bliss and sometimes it's better just to give them steps forward instead of telling them just how truly bad they really are.
00:23:59:01 - 00:23:59:12
Speaker 2
Yeah.
00:23:59:15 - 00:24:27:02
Speaker 4
I mean, so I would I would say to your original question, Kyle, if someone comes in and starts to speak in sort of anatomical terms, so again, using you as an example, like you knew what your talus was, you knew what you're talking was like, you know where they're at. So if someone comes in with that level of education and they're sort of involved mentally in their recovery, it makes a little bit of a richer sort of physical therapy and rehab course.
00:24:27:18 - 00:24:51:16
Speaker 4
It is as a provider, somewhat intimidating because you're like, Oh no, have I studied that anatomy recently? And sometimes you have it and you're just like, okay, let's see what they have to say. And then if you start to get somebody who delves into, you know, their own belief structure and sort of their own conclusion, that's a really hard thing to unwind as a provider.
00:24:52:03 - 00:25:19:18
Speaker 4
And personally, I haven't found it to be a very successful thing to do, to be like, Well, you know, you're wrong. This is me on the authority. You know, I try and sort of nibble at the edges. So just you sort of acknowledge their their self education, right? You never say, oh, you went to Doctor Google and like make it a joke because it's like it's so insulting to these people who are choosing to come to you.
00:25:20:01 - 00:25:38:08
Speaker 4
They're spending their time and their energy and everything like that. So you try not to do that. And to sort of Kevin's point, there's like this whole class of physical therapy discipline called pain, neuro education. Yeah, it is. It's like basically pain science. What does that stand for? Kevin do you remember what it written down?
00:25:38:09 - 00:25:39:21
Speaker 1
Pain, neuroscience, education?
00:25:40:05 - 00:26:06:15
Speaker 4
Yeah, I think that's what it was, but it's just like this whole group out of Australia, it's sort of his name there. Amir, mostly, if you want to look them up, is absolutely hysterical, frankly. And David Butler and they sort of pioneered this whole idea about how your words matter and then the value of those words, you know, evidence is indicated that a positive provider, believe it or not, has been ellagic effects.
00:26:06:22 - 00:26:33:01
Speaker 4
So you can actually make a statistically significant change in people's pain perception within a session just by being optimistic. It's like just one of the crazier things that we've seen. So we try and be optimistic. We try and avoid terms like, Oh, you're broken or your back screwed off. Like you'll never be the same. Like all those things have no value whether or not it's necessarily positive, like there's a positive prognosis.
00:26:33:13 - 00:26:42:16
Speaker 4
We still kind of nibble around the edges on that one. So it's it's really cool stuff, frankly, because there's good science behind it, too.
00:26:43:00 - 00:26:59:14
Speaker 1
That's that's super fascinating for sure. And obviously, like, you know, back to I think the whole beginning of this so far has been that underlying of the psychological aspect of the bias like social model. Right. And I think there's obviously like a fine line you need to like like you need to you need to properly educate.
00:26:59:14 - 00:27:00:02
Speaker 3
Someone.
00:27:00:02 - 00:27:02:21
Speaker 1
You know, like they need to have, like, realistic expectations and stuff.
00:27:03:02 - 00:27:04:20
Speaker 3
But at the same time, there is a.
00:27:04:20 - 00:27:36:01
Speaker 1
Lot of nuance in perception. And I know speaking for myself, just coming out of quite a what I would call for myself a traumatic injury, right? There were really, really dark periods where I was in this kind of cognitive decline and, you know, washing machine things over my head like I'm never going to be like people to do the things I want to do and like I, you know, insert x a million bad things to pain so bad and and that like drastically affected just my mentality physically, how I felt.
00:27:36:01 - 00:27:59:00
Speaker 1
I was lethargic at the time and stuff. And so I generally feel like anecdotally and from my own experience, you know, having that little bit of positivity, having that optimism in your life and in your experience and, and also like you can word something to someone like, okay, you know, you can never do X again. Like that's one way of wording it.
00:27:59:00 - 00:28:22:07
Speaker 1
Another way would be like you have new limitations and you don't want to damage these limitations, but you know, we don't actually know exactly what that line is. So let's not jump to any conclusions so far, you know what I mean? Let's work hard and let's get the the you in the best possible space that we can do to be successful in your life and to feel good, you know what I mean?
00:28:22:07 - 00:28:34:19
Speaker 1
Like, there's just it's virtually the same communication. Ultimately, you're damaged and you can have a limitation, but one is very definite and it can be psychological, be like, oh, well, you know, to Kyle's, you know, terminology here I.
00:28:34:20 - 00:28:38:00
Speaker 2
Clock and you know.
00:28:38:08 - 00:28:48:06
Speaker 1
And the other one is like, okay, well, like, you know, maybe, maybe I am foc, but we don't actually know that yet. So let's, let's find that out, you know, like a new limit of mind.
00:28:48:11 - 00:29:06:06
Speaker 3
I think right there, that's the key. I think that a great way to approach it is, yeah, you're injured and you're going to have some limitations, but go find them. Go find the limitations. Find the edge of of where you are now instead of telling you like, okay, these are your limitations. It's like, how do you know you got to go find them.
00:29:06:06 - 00:29:15:15
Speaker 3
You got to spend years trying to recover and get back to where you were, and you'll find where it stops. But it's on you to find where those edges are. Not someone to tell you where they are.
00:29:15:19 - 00:29:36:10
Speaker 4
Yeah. I mean, your body is a way of speaking to you in a lot of ways that we as physical therapist just interpret. And, you know, Kevin talked about these asterisks, right? We have subjective asterisks. So it's like you can't do this for this long because it hurts this amount. Right? Basically. And we can just track those and we can say, well, how is this compared to where we were first?
00:29:36:10 - 00:30:02:10
Speaker 4
And then we have objective asterisks that we're like, Well, I can't do this. And then my shoulder motion is off by 15 degrees or whatever. And so we can track those and then we can marry that together and have a great idea of whether this is working. And then, B, what's your prognosis? And I think we kind of think about like muscle imbalances and all those things like getting through all that stuff is wonderful and it's all part of your recovery.
00:30:02:20 - 00:30:09:06
Speaker 4
But it does sort of start with the subjective and then sort of builds off of there.
00:30:09:06 - 00:30:22:20
Speaker 1
Yeah, one of my favorite parts of the whole job is taking somebody when they're in the acute phase of an injury and just working through them week by week and slowly seeing them improve and you can tell they just want to they want to go, you know, they want to go for the run or play the soccer or whatever.
00:30:22:20 - 00:30:35:21
Speaker 1
But you're kind of holding them back a little bit. You're saying, I promise I'm going to get there, you know, just and they're anxious and they want to get going. And eventually you're like, all right, it's time to go, you know? And you let them go and you let them run. Let me know how it goes. And you come back the next time and they come back and the next is in their beanie.
00:30:35:21 - 00:30:53:20
Speaker 1
You know, they did it. They feel good. They went for that five mile run, didn't have any pain. You know, it's like but you know, because to your point, you know, you got to give it a shot. You know, you can't just waiting forever. You know, you got to be aggressive at times. And obviously that's up to your duty and Doc's knowledge to know when to give them a green light.
00:30:53:20 - 00:31:00:07
Speaker 1
But it's the most rewarding thing in the world when they come back and they're just the big smile on their face and they're stoked to tell you how good they're doing.
00:31:00:20 - 00:31:25:23
Speaker 4
We have foundational like objective tests, right? So Kyle, you know, if you want to talk a little bit like when we first met, Kyle couldn't do a calf raise. And we know based on sort of what our our testing is like, normal is 25 calf raises single age, right? We know that to be normal. And if we're going to say, okay, you want to participate in sport, well, you're not normal yet.
00:31:25:23 - 00:31:37:07
Speaker 4
So these are the consequences to the recommendation. But it shouldn't prevent the patient from trying different things. And I know personally from past experience that he wasn't strong enough, but still in climbing and did fine.
00:31:38:07 - 00:31:43:21
Speaker 3
I still I'm still struggling with the with the calf raises. I'm doing I'm doing them on the side of the stairs.
00:31:44:15 - 00:31:44:17
Speaker 2
And.
00:31:45:03 - 00:32:11:11
Speaker 3
Strength back a little bit. But it's it's like getting a full body weight on one leg calf raise with full range of motion with how damaged I was is it's really hard to get that back. And I'm like, I'm seeing progressive, progressive return of strength. I definitely have a lot more strength, just like static. Like I can get myself into a flex position and then stand on it and not have it collapse.
00:32:11:19 - 00:32:30:05
Speaker 3
But like getting up into a full calf race is nearly impossible still. Yeah. So it's just like it's a big, it's a like a long road. But yeah, I mean, those metrics you gave me, it's really, it's really nice to set those goals and just to have those, those actually foundational numbers to, to be chasing and to measure your, your progress.
00:32:30:12 - 00:32:50:03
Speaker 1
And I think there's a good point to be made there for for the listeners and stuff like if you guys do find yourself in a beauty clinic injured, you should definitely find some pitches and docs and providers that have a plan and they have specific return to activity, returns for metrics, things to measure. So it's not a guessing game, right?
00:32:50:08 - 00:33:04:08
Speaker 1
They need you guys need to prove that you can do these things. Before we let you go. So don't, you know, try to avoid the practitioners that's kind of puts through the random stuff and say, oh, you're going to you're good to go now. You know, that's not going to be going to work out well because I think.
00:33:04:08 - 00:33:05:04
Speaker 4
An interesting.
00:33:05:04 - 00:33:05:09
Speaker 3
And.
00:33:05:09 - 00:33:23:18
Speaker 1
Interesting point I'd like to bring up that I think I've talked about before in previous episodes and for people who are listening is, you know, it's it's I've called it your support group, right? And so it's kind of building a relationship with your support group because the human body, we're all ticking time bombs ultimately, you know, none.
00:33:23:18 - 00:33:24:07
Speaker 3
Of us is going to.
00:33:24:07 - 00:33:57:02
Speaker 1
Live forever. Our bodies are going to slowly deteriorate. Some people are going to do much better than others. And so do you want to try and find a support group when you're going through a traumatic injury or you're really hurt or something's going wrong or you want to maybe a have an approach to prevention, you know, from from being injured and then be if something does go wrong actually already having that that you know psycho bio psychosocial relationship with somebody who can help you out, you know, through that kind of process.
00:33:57:02 - 00:34:17:23
Speaker 1
Right. And so, you know, I kind of say this is that like it's it's not a bad idea to just, you know, find find a therapist or find somebody. Do an assessment. Go get your body checked out. Find out what your muscle imbalances are. Maybe get like a routine check in once a year, even if you don't feel like you need it or it's not something you do.
00:34:18:18 - 00:34:54:23
Speaker 1
Yeah, I'm a pretty big proponent of saying like, I think that that's a really a really good idea for people to do. And as we discussed earlier, people really want that, you know, that acute manipulation by somebody like people talk to anybody, they go for massages, they, you know, they go to the spa, they do whatever. But I know really few people who are like, Oh yeah, like I checked in with like a physical therapist or my physio once a year and you know, and we're seeing improvements or we're not seeing bad muscle imbalances or my body is doing well and I just think it is an interesting relationship there that I think people could
00:34:54:23 - 00:35:01:16
Speaker 1
probably really benefit from doing something like that. Max, you you speak for yourself. I'm doing the Joe Rogan routine.
00:35:02:08 - 00:35:02:16
Speaker 2
I've got.
00:35:02:16 - 00:35:03:12
Speaker 1
The cold plunge.
00:35:05:00 - 00:35:09:18
Speaker 2
And the metformin. Oh, man, you go.
00:35:11:01 - 00:35:33:05
Speaker 1
No, I'm just I'm I'm just kidding, you know? But it's a good really good point. You know, and that's one thing that we as a community have been pushing for is treat us like a primary care provider, that we can do these maintenance checkups, right. Like preventative checkups. An ounce of prevention is worth a pound of cure. If you go to your dentist once or twice a year, why don't you come to us once a year?
00:35:33:22 - 00:36:06:14
Speaker 1
Some insurances will let you go straight to a party. And so you can take advantage of that. Some insurances you need a referral, but I mean, that's what we're trying to do. We're trying to pick up on musculoskeletal impairments. And those impairments might be some pain impairments right now where you're walking around these dysfunctions, but it hasn't turned the pain yet, you know, but that, you know, next step or next time or next twist or whatever could be the one that that kind of lets you up and set this whole thing in motion so we can do a good job of preventing that stuff and identify some of those issues to work on.
00:36:06:14 - 00:36:42:09
Speaker 3
Yeah. So I think this, this is to me, it's a great transition. I think we should talk about some of these situations that we can avoid. You know, I think moving forward in into the rest of this podcast, we're going to be talking about traumatic injuries, you know, repetitive strain injuries. I'm curious, as you know, before we jump into the injuries themselves, let's talk about some of these muscle imbalances and some of these motion patterns that people have, especially when it relates to climbing that you guys have seen that people can just fix now and avoid getting themselves into some of these injuries they're going to be talking about later.
00:36:43:03 - 00:37:15:02
Speaker 4
Yeah. I mean, so I would say there's my interest is more lower extremity. So I think the one that came out most in light is a muscular imbalance between sort of quadriceps strength and gluteal strength and the impact that has in sort of closed kinetic activities. So primarily what we see is we see this dynamic knee values moment where essentially is when somebody plants their foot dynamically, they get inward collapse of the kneecap.
00:37:15:02 - 00:37:37:19
Speaker 4
So you get sort of an internal rotation of your hip, your knee collapses towards the midline, and then it puts you in a very susceptible position for a major knee injury climbing. You're most likely going to see that sort of in bouldering or potentially in sports where you fall to the ground and you need good loading mechanics or you swing back into the wall and you need those floating mechanics.
00:37:38:05 - 00:38:07:01
Speaker 4
So technically, believe it or not, you're supposed to have a 1 to 1 ratio between your gluteal and quadriceps strength. And Kevin, if I'm wrong on anything, tell me. But I mean, that's like obscenely obscenely strong with musculature. And then specifically, we work in sort of a forward and back or sort of sagittal plane motion where our knee is dynamic and it works in mostly when you're putting the forces, when you're moving dynamically, it's transverse or rotational.
00:38:07:18 - 00:38:38:22
Speaker 4
So we train a lot up and down. We don't train a lot in any kind of torsional motion. And so you see this massive imbalance in your glute medius, where there's high level athletes, professional athletes, even in dynamic sports that have what would be subpar medius strength, and particularly women athletes, soccer players, they sustain like traumatic knee injury, 25% greater because of this sort of muscular imbalance.
00:38:39:07 - 00:39:16:00
Speaker 4
So, you know, the one person I would probably recommend a lot of like sort of self-motivated people to look up is Chris Powers. And if you follow sort of a Chris Powers Glute medius strengthening program, I'm sure there's a ton of stuff on YouTube or any of the social media, but he he does a wonderful job correcting the dynamic knee values and that would be sort of where I'd start from a lower extremity standpoint, that has been probably one of the most powerful exercise routines and the best exercise I could give is a standing clamshell or fire hydrant.
00:39:17:11 - 00:39:23:14
Speaker 4
If you can do one of those, your lower extremity mechanics are really, really good.
00:39:23:14 - 00:39:48:06
Speaker 3
Yeah, this this particular topic is something of extreme interest to me. I have the less scientific terminology that I refer to this this particular situation, it's just being quad dominant. Yeah, I feel like a lot of people are quite dominant and I encourage our listeners and to to go around and look for what Mat's talking about. Go look around.
00:39:48:16 - 00:40:14:12
Speaker 3
Unfortunately it's super prevalent in women. Yeah, but look for that, that knee concave that almost that like triangular leg position that's inward knees touching on the insides. Like you put the foot down, the knee collapses inward. Yeah, someone doing a squat and their knees are inward and it's just like it's horrific. I see it every anywhere. Yeah, everywhere.
00:40:15:00 - 00:40:20:05
Speaker 3
Yeah. And it's like some people are so bad, I want to come up to them and just give them a quick awareness.
00:40:20:22 - 00:40:27:10
Speaker 2
Give given my business. Yeah, yeah, yeah. Exactly. Like you're you're.
00:40:27:10 - 00:40:51:03
Speaker 3
Squatting £200 and it's all on that one quad muscle right above your knee. And I'm like, this is really scary to watch. And so to me that, yeah, like this is such a huge topic. It's really important to train that posterior chain. Yeah. To use your glutes, got to use the hamstrings, got too loose, use the lower back and it's just super, super important for, for climbing because what are you supposed to do on overhanging stuff?
00:40:51:03 - 00:40:57:19
Speaker 3
You got to keep your hips close to the wall. Yeah, that's all posterior chain. And so it's just really, really important for people to pay attention to this.
00:40:57:19 - 00:41:12:16
Speaker 4
So no. Yeah, I mean, so another visual cue for somebody who's looking at themselves and doesn't know what this means. If if you're standing and your kneecaps are looking back at you and then you squat and your kneecaps are cross-eyed, you got some problems.
00:41:13:08 - 00:41:17:05
Speaker 2
You need to see somebody quickly.
00:41:18:11 - 00:41:38:00
Speaker 4
Quickly, because you are a time bomb and women for a variety of reasons that we want, we don't necessarily have to go into. But, you know, they're way, way more susceptible than men. And I think for me that's been like probably the most prominent and prominent movement dysfunction for the lower extremity.
00:41:39:00 - 00:41:49:10
Speaker 1
So if we were talking about this kind of like, you know, antagonist agonist kind of muscle, you know, posterior chain, what like.
00:41:49:20 - 00:41:50:22
Speaker 2
What is the.
00:41:51:01 - 00:42:11:04
Speaker 1
What is the general approach you're going to take to somebody? So like you're going to give them their physical assessment, maybe take them through some range of motion and then like, what are you building into is the ultimate goal to get them into actually being able to properly load load the muscle to strengthen it, maybe just like take us through what somebody could do through that process a little bit.
00:42:11:04 - 00:42:40:21
Speaker 1
Yeah, I mean, it's kind of funny. You go through school and you're like, okay, you got to memorize all these things. Or The shoulder should abduct 175 to 185 degrees. You know, the strength ratio should be this and that. You pretty much take that and throw it out the window, you know, because for me, at least, what I really strive for symmetry, you know, if it's a right shoulder issue, I want to see the left or the right sort of move just as much in as smoothly and in the same sequence as the healthy shoulder and the strength should be the same as the healthy shoulder.
00:42:41:21 - 00:43:02:05
Speaker 1
So something with imbalances. I'm not comparing you to what it said, and I'm forgetting what it is on the other side, you know, and that's been a valuable lesson learned early in my career. And then so as far as like if you are looking at the other side and let's say the other side was much more dominant, what's what's your approach like?
00:43:02:05 - 00:43:10:20
Speaker 1
Are you starting out with isometric exercises like body weight, range of motion? And then are you eventually getting into floating depending on the muscle?
00:43:10:20 - 00:43:35:01
Speaker 4
Is yeah. I mean, so I think of it this way. This is an old like theory, but it's an app like it's old. But essentially what he talks about is pain and muscle contraction. So you talk about sprains or strains or anything like that. So the first thing is like if there's in the acute phase, we want to load that muscle in a pain free manner.
00:43:35:18 - 00:44:07:07
Speaker 4
So typically what that means to me is we start off with isometrics or some level of position where it doesn't provoke, there are acute pain symptoms and then from there you can go into concentrix. But I'm biased towards function because ultimately that's where we want to go with surgical therapies is a return to function. Doing, like Kevin said, like these sort of some of these tests, they're just fancy stuff for us to do, but they don't have functional value.
00:44:08:06 - 00:44:38:18
Speaker 4
So I'll go into loading in a functional way and mostly being sort of pain driven so it doesn't hurt that we can push it. We can put it into more provocative positions and sort of load from there, but typically it goes isometric, the concentric. And then the ultimate goal is that eccentric loading because we know that eccentric loading is actually what remodels tissues and that's where you're going to develop sort of more of that symmetry that Kevin eloquently described.
00:44:40:11 - 00:44:58:04
Speaker 1
And to kind of dovetail off that, too, I mean, that's those are all good points. And I think in addition to that, something that I've used in my arsenal is putting, you know, especially it's a muscle or tendon. This issue. Like first off, if it's now irritable, you know, if if it's extremely irritable, we're doing pain modalities, we're trying to get that thing calmed down.
00:44:58:05 - 00:45:14:07
Speaker 1
That's the place where you want to do maybe a little ice, maybe a short course of something to just get it to work and tolerate something. Right. And then with isometrics, like Matthew was talking about putting the tissue in a shortened position, that's going to be a lot more tolerated for these people than the mid-range or a lengthened position.
00:45:14:07 - 00:45:36:04
Speaker 1
So, for example, for thinking like like climbers get a lot of like tennis because they're gripping all day, which is the front of their former flexors, but the extensor is on the back of their forearm, aren't pulling their weight. So they get these outside of the elbow pains, lateral. Often the alga is the name that they're using now, and you might find something that's super hot right outside their elbow.
00:45:36:04 - 00:45:54:15
Speaker 1
You can't even touch it without them yelling at you. Right. It's incredibly painful once you get that pain down and problem that rift up, right? Like I'm putting that risk in kind of a position in extension that's going to shorten all of those tissues, put them in a little bit of a protected position. And so my acid matrix there now might be able to do right.
00:45:54:16 - 00:46:15:02
Speaker 1
I mean, low load essentially is king. Like that's at the end of the day, if you're treating the muscle or attendant, you need to load the tissue and that might be all a load of tolerance. And then next day I'm putting him in more of a mid-range where your wrist is just neutral to either tolerate that. And the next time they come in, if they're tolerating stuff, I'm putting them in some flex position where I'm actually putting that muscle on tension and then asking it to contract.
00:46:15:14 - 00:46:32:10
Speaker 1
If they're tolerating up, then we're moving into isotonic, so we're actually lifting weights up and down, up and down, up and down. And then it just goes from there. And then we're just I mean, we're cranking on it. We're making them work super, super hard. And eventually that takes it takes some time with especially attendant issues, but that load is what's going to stimulate the healing.
00:46:32:21 - 00:46:50:12
Speaker 3
So in that in that case, specifically like in in the tendon and this like overuse kind of situation we're talking about, can you run through because I'm curious what is actually causing the discomfort, what's causing the pain like that anatomically? What is causing that pain?
00:46:51:05 - 00:47:12:11
Speaker 1
Great question. Yeah. So I mean, there's you can think of those tendon issues as either tendinitis or tendinitis. Tendinitis, everyone's heard before, maybe not everyone else's, but in acute injuries, you're dealing with a tendonitis. I just means inflammation. Right. So that's the example. I was talking about the beginning where so I can touch it. But you got to come on down to the pain generator.
00:47:12:11 - 00:47:36:17
Speaker 1
There is probably some like return and attendant inflammation itself. That's causing pain, right? The chemical pains and the information, whereas I tend to notice it's more of a chronic issue. You've got these people with chronic Achilles tendinitis analysis, patellar tendon, this elbow issue and what's happening there is that that initial injury or that the slow development of injury is actually tearing some of the college and tissue.
00:47:36:17 - 00:48:01:21
Speaker 1
Right. You can think of these millions of carbon fibers. A percentage of those are getting torn, which hurts. Right. And then your body is not humid properly. Like the college. It is not naturally laid back down in the same parallel, nice, long, strong pattern. It's going to lay down this like really unorganized, kind of haphazard pattern. And that alone is painful like that tissue is not functional, right?
00:48:01:21 - 00:48:23:19
Speaker 1
It's innervated with nerves, hurts. We've got to stimulate through load some proper human tissue. In addition to that, all of this chronic product tendon stuff, they get little or little blood vessels that infiltrate the the poorly healing tendon. And you think, well, this is great. I mean, that's going to supply blood, but it actually does. In this case, the blood vessels are on the periphery.
00:48:23:19 - 00:48:50:17
Speaker 1
They don't get down into the actual tendon and that can give you some pain as well. So that's kind of the pathophysiology, that issue. So when you're talking about getting it under load to heal it, could you explain a little bit more about like like what about getting it under load is actually promoting the healing process? Yeah. So when you are loading so tendons, you know, muscles attach tendons to bone.
00:48:50:22 - 00:49:17:19
Speaker 1
So the muscle transitions of the tendons attach to the bone by contracting the muscle and applying this tension load through the muscle tenderness junction. In the tension itself, you're stimulating fibroblasts, which are these little cells to lay down new college and tissue essentially. And this new called tissues should be in line with the proper line of force, and it's going to slowly overtake some of that crappy tissue that was being laid down earlier in the process.
00:49:18:04 - 00:49:40:11
Speaker 1
And that essentially is going to improve the tensile strength about tendon and improve your pain. I think that's that's really important. And, you know, the thing is that it might seem counterintuitive to some people who don't like to think about like loading things a lot. And sometimes there's an interesting line to teeter on of like, okay, I need to listen to my body.
00:49:40:15 - 00:50:07:18
Speaker 1
But when you understand the physiology and the you could say the biochemistry and you know enough about your body in the circumstance, then you are able to actually know when to push and when not to push. Right? And so there's times with my own injury where, okay, I might not feel really good. And some of those times are legitimate time to like you need to have this intuition or have a professional who can let you know, like this is not the time to push like this is.
00:50:08:00 - 00:50:30:18
Speaker 1
This is literally something is is is wrong, you know what I mean? And then there are other times where it's like, okay, I feel bad, it's incendiary, I feel tired, something's a little sore, but like it's not actually injured. It's not over inflamed. It's not giving you that bad feedback. And when you do go, you exercise it, you load it, you push it, you stress it, you pump blood and fluid and limp in there.
00:50:31:10 - 00:50:55:21
Speaker 1
All these things it actually contribute to the healing. So I just think for some people listening, that might seem counterintuitive that like a weight but it's hurt. Don't I need to leave it alone? It's like right. There's there's there's an interesting nuance there, right? That like maybe depending on how acute and how inflamed it is, but generally like active recovery is is always, at least in my opinion, are put words in your guys's mouth.
00:50:55:21 - 00:51:04:07
Speaker 1
It's you know more about this than I do. But active recovery to me is is always a better way and usually supports your body and your health more. Right.
00:51:04:07 - 00:51:34:00
Speaker 4
So yeah, Max, I have like some real simple parameters that I give most of my patients, especially if they're tentative about doing these things. And so we have the numerical pain rating scale, right, which is sort of generic and people somewhat disregard is actually a very powerful sort of self detective tool. And what it allows us is this is like my two is different than your to Kevin's five is different than my five but between myself I always know what my two is, right?
00:51:34:09 - 00:51:57:16
Speaker 4
And so I tell people this 0 to 3 is mild. You know, 4 to 6 is moderate, seven and above is severe. Right. But here's the kicker, right? Even in severe pain states, it doesn't necessarily mean it's like nociceptive, which is like pain with damage. Right. It could be some kind of like pain signal that goes beyond your tissue changing.
00:51:58:02 - 00:52:21:23
Speaker 4
And so, frankly, I tell people, we can load you very comfortably. Our baseline pain level is whatever it is during the activity we can raise up by one point, right? If we go to points in above. Now we're getting to somewhat of a danger zone where we could be causing damage. Right. But if we do one point and then when we stop the exercise and the symptoms, go back down to your baseline in less than an hour.
00:52:22:17 - 00:52:49:00
Speaker 4
We're all right. Right. That's an okay loading session. And then, you know, so you have that during. Right. So you can't go above two. You have an hour later timeframe where it should go back to baseline. And then I tell them the next day, your pain level should not cause functional loss. And what that means is if we go and we have a new knee or something like that and we say, okay, we've done a lot today, this morning, what was that like rising out of your car?
00:52:49:13 - 00:53:07:21
Speaker 4
And then the next we do a treatment, do exercises, blah, blah, blah, all those parameters within session, they're fine. The next day it's hard for you to get out of your car. Then we have to reevaluate our loading principles. And the nice thing is, you can be that detective. You don't need me there to tell you. Oh, it's a do today.
00:53:08:12 - 00:53:27:08
Speaker 4
Is it a two now in an hour or the next day, is it harder to do something that was easier before the treatment? And I found that to be a very successful way to push people and they can do it themselves and they can report that back to me in three simple questions. And then we know what we did was okay.
00:53:28:07 - 00:53:31:09
Speaker 3
I'd like to challenge that a little bit, if you don't mind.
00:53:31:09 - 00:53:32:23
Speaker 4
No, go for it. Yeah. Yeah.
00:53:32:23 - 00:53:43:18
Speaker 3
So you're I guess mostly the the rule that you have in state where if the pain goes up the next day, you said by one, right. That was the metric one point the next day.
00:53:43:23 - 00:53:51:11
Speaker 4
So it's, it's basically doing the activities at one point you shouldn't go above two points, but then if you recover in less than an hour.
00:53:51:16 - 00:53:52:12
Speaker 3
The next day.
00:53:52:19 - 00:53:53:05
Speaker 4
The next.
00:53:53:05 - 00:53:54:23
Speaker 3
Day, the next day, what about like so.
00:53:55:14 - 00:53:55:20
Speaker 4
Yeah.
00:53:55:20 - 00:53:58:11
Speaker 3
So that's you're saying loss of mobility, loss of function.
00:53:58:11 - 00:54:03:10
Speaker 4
It's more a functional loss and it's an imperfect it's an imperfect thing, but yeah.
00:54:04:15 - 00:54:23:04
Speaker 3
That's fine. Yeah, I guess I challenge it just because like in hypertrophy workouts sometimes I'll wake up the next day and I can't even reach behind my head. Right, you know, like, right. And so and for instance, I just went for a run yesterday. I ran a mile and today I'm limping around. I definitely lost function.
00:54:23:04 - 00:54:23:14
Speaker 4
Sure.
00:54:24:05 - 00:54:44:22
Speaker 3
But it correct me if I'm wrong, this is my own personal journey here. But I feel like without those those moments where I'm pushing the envelope and I am kind of in pain the next day, I won't progress I feel like in my understanding that rule where like, okay, I can't do anything where I'm going to be limping the next day.
00:54:45:02 - 00:54:51:19
Speaker 3
I feel like it's going to slow down my process a lot. Like do you have any kind of notes on that and how strict this rule actually is?
00:54:52:06 - 00:55:22:05
Speaker 4
Right. So that's a great, great discussion. And so the one thing that I would like to emphasize is there's a difference between a pathological state and then a training state, and it's not a steadfast rule. So you have self beliefs that will outweigh any opinion that I give you. Right. But if you're in a pathological, active tendonitis state or recovery state, and you do that, you could be setting back your recovery, for instance, in a bone.
00:55:22:10 - 00:55:48:06
Speaker 4
You could cause a union. You could cause a serious issue in a tendinitis episode. You could continue to cause an uncontrolled inflammatory state that we misinterpret as sort of this, okay, this is just normal because of the loading process. So there's a lot of nuance to it. And you're right, you should push back on it because your self belief and your background dictate that you need to push yourself.
00:55:48:06 - 00:56:08:12
Speaker 4
And as a therapist, I would just say in being your therapist at times I would say that's okay and we'll have to restructure what our thought processes in order to best get you to where you need to be. And Kevin is going to know quite a bit more in regards to performance and return to performance in those situations.
00:56:08:21 - 00:56:23:21
Speaker 4
But I would say that would be a great conversation and it would be probably as a provider incorrect for me to be like, well, you know, you got to stick with these roles. I would say, okay, let's see where we are. We can do some objective tests and then give it some more time.
00:56:24:12 - 00:56:26:09
Speaker 1
I think there's also I think I think.
00:56:26:09 - 00:56:27:22
Speaker 3
That you're sorry.
00:56:28:16 - 00:56:32:19
Speaker 2
What about you? You don't see the topic.
00:56:34:01 - 00:56:56:21
Speaker 3
So yeah, mine is going to be well, it's going to be really quick. I think that you brought up a good point. I think that that rules the rules that you outlined there are really applicable to the beginning stages of a traumatic injury or the current stages of a chronic injury, something where it's very severe and you are at risk of mal union, you are at risk of rupturing you.
00:56:57:07 - 00:57:14:18
Speaker 3
That is where you do have to play the line really safe and you do have to be cautious about how much load you're putting on on this particular injury. But my example, I'm ten months after injury, my bone is fuzed, my tendons are going to be rupturing and so I'm not running that risk. I don't have that risk.
00:57:14:18 - 00:57:25:20
Speaker 3
And so I can push boundaries a little bit more. And that's kind of where we're switching to is that getting back to performance versus recovering from an immediate acute injury.
00:57:26:11 - 00:57:53:00
Speaker 1
Causing an important distinction as well along those lines is differentiating between, you know, delayed onset muscle soreness and normal training adaptation and, you know, your pathology. Right. There are two different things like so for example, if you went running like I ran on my calves or just sort of like really on stairs and quads are on fire still my ankles fine, my ankle is not swollen, it's not extra stiff and sore, not pinching.
00:57:53:06 - 00:58:10:11
Speaker 1
I'm perfectly fine with it. Right. That's all good. But if you come back to me, you say, Yeah, I'm exhausted. If I can't move, it's blown up. Then I've treated too much. Right. We've got to back down. If it's more than that. Well, so I think I think what I usually ask people come in all the time. They're like, oh man, that last workout killed.
00:58:11:02 - 00:58:32:14
Speaker 1
And I was like, What do you mean? Like, Well, I'm sort here. And they point to their they're outside of their hip. You know, there are any patient that they're in for, like a small issue or something like that. I'm like, awesome. You're like, That's perfect. That's exactly, you know, that's modern. It comes back to education piece, you know, like, well, this is what we got to do this and we get stronger and that's why your saw and like it for tomorrow even more.
00:58:32:14 - 00:58:55:01
Speaker 1
Right? But how's your knee doing? Oh, my knees, actually. Fine. Okay, we're going right. We're right on track. So takes a little digging sometimes really differentiate between pathology and workout soreness, muscle soreness, things like that. I think. I think it's like is well it's a spectrum, right. And so someone who maybe is way more in tune with their body, they're way healthier, they have a way larger background and exercise.
00:58:55:08 - 00:59:21:11
Speaker 1
They might respond to this a little bit better. They might feel faster. They might be able to like teeter the line a little bit more and that's where to me I think of it as a spectrum. But I think going back to that functional loss, a coach that I idolize, this guy, Scott Johnson, he is a good description I think he has of it based on functional loss is essentially like so if you have like a repetitive strain, like a tendinitis or, you know, plantar fasciitis or something like that, right?
00:59:21:11 - 00:59:41:10
Speaker 1
You wake up in the morning and you're like, Oh, it's really hurting. He doesn't feel good. And then all of a sudden you're pumping blood into it and stuff and oh, like in the middle of the day, you're good and you go do your workout, right? So it's back to that, you know, okay, you got yourself in a state where you felt okay, but like ultimately the way you woke up was actually a much better sign of how your body was doing.
00:59:41:12 - 01:00:01:06
Speaker 1
Then once you like, you know, stimulated an area and pump blood and stuff like that into it, you know, because ultimately I think it was back what Matt was saying where overall like you might be able to do some of that, but there's probably a pretty good chance that you're going to be slowing your healing time or long gating the damage that you have.
01:00:02:00 - 01:00:27:23
Speaker 1
And obviously, there's there's caveats to this with everybody. And then as well, I think from your guys's perspective, you know, you guys have to go off of averages right there has to be some kind of standard that you can adhere to. And so as a generalization, when you're talking to most people, I would think that, you know, for the majority of people, you know, if you have distinguish between, you know, like DOMS, you know, delayed onset muscle soreness, you know, and you do have that functional loss.
01:00:28:07 - 01:00:48:00
Speaker 1
It's probably pretty safe for a lot of people to be like, you know, like, you know, fact is Scott Johnson actually, you could say he has it's like it's generally better to be undertrained than overtrained, you know, undertrained. You can you can like and this is more pertaining to racing and stuff, but you can dig deep and you can pull a little bit more out of the gas tank and use willpower.
01:00:48:04 - 01:01:01:04
Speaker 1
But once you're overtrained or your heart or you're damaged, like you're you're kind of whooped until you take a break and things heal. Right. So it's it's a distinction there. I just think interesting from from my perspective.
01:01:01:04 - 01:01:33:17
Speaker 4
Yeah. And what I would say, Kyle, is this is like if you find a provider and you challenge that provider in a way and they sort of scoff and back away, you know, or like say, hey, that's not not what I know or believe. You're probably at the wrong provider. So, you know, I would say we got to give space to our patients to express their self beliefs because that's a really sort of powerful thing when you can connect and get the patients and your belief structures together and like you need that symmetry in order to have like a good rehabilitative course.
01:01:34:04 - 01:01:54:08
Speaker 3
Yeah. And I think there's a line between like pushing yourself and being dangerous. I think that yeah you could just, you would understand the actual, the limit, that line of where it's like, all right, like, you know, you're doing this. I'm going to warn you that you might screw yourself up pretty bad. Like, here's my warning. And I think that that really goes back to the beginning stages of the injury.
01:01:54:08 - 01:02:02:18
Speaker 3
It's like really important not to push it too far. Yeah, because you can like you said, like the bone not coming together and rupturing tendons like those are real risks.
01:02:03:10 - 01:02:23:01
Speaker 1
And I think it's important to to like if you if you get a patient in front of you who's going to push too hard, you know, and, you know, that's that's their personality and they want to go for it is the channel their energy in something else you know like runners go hit the spin bike go crazy on the spin bike you know you can do that for hours if you want because it's not going to is not Weyburn on your heel or, you know, whatever.
01:02:23:11 - 01:02:38:12
Speaker 1
And just finding activities and whether it's weightlifting or biking or swimming or whatever and activities where your your doc gives you the green light and just go crazy that you just do it. It's some of the competitive juices out to get some of the endorphins running and all that stuff. So good for you.
01:02:39:15 - 01:03:14:23
Speaker 3
Nice. Seems like we're we basically covered the topic of repetitive strain injuries. Do you go, oh, actually, I have one more. We kind of chatted about this in our pre call it's the the over the hunch or active back overgrowth and the climbers back yeah the climbers back the climbers. How can you guys kind of talk about the anatomic causes of that and the risks people run and the injuries you've kind of seen from this stereotypical climbers back that we see all the hard climbers have in the gym?
01:03:15:06 - 01:03:36:12
Speaker 1
Yeah, absolutely. So I was talking about I'm sure, you know, if you've got a listening group that are full of climbers, they all know what we're talking about. But people that have, you know, this mid back that's excessively forward bent, they're they're kind of hunched forward, their shoulders around and forward your palms or facing backwards, you know, their heads kind of protruding.
01:03:36:12 - 01:03:52:07
Speaker 1
You know, we all know what the paint, the picture I'm painting here. And what happens is, you know, new to climbing, it's such a, you know, a flexion dominated sport, meaning that you're hanging onto a wall, right? So your arms are point down, your legs are point up, your core is pushing you forward like you're almost doing a crunch.
01:03:52:20 - 01:04:14:03
Speaker 1
Right. And all those forces are contributing to that posture. There's so much point with your arms. You know, you're you're such a dominant sport and those laps are internal rotators of your arms. So that's why the arms and up facing backwards and shoulders around and forward, the external arm just rotated internally. And this can lead to just a whole host of issues.
01:04:14:11 - 01:04:35:00
Speaker 1
This is this is the posture you see in climbers. You also see people that sit all day in their computer and they hunt for the they text other students, you know, things like that, you know, starting from the top down. Their head is so far forward. Right. They say that your head weighs £12 and it's straight up on top of your shoulders when it moves forward, two inches, it's now £16 will move for two more inches.
01:04:35:00 - 01:04:44:07
Speaker 1
It's now it's £30. Right. And that's your neck joints, your muscles, your everything's got to support so much more weight. So you can imagine everyone in Nepal right now.
01:04:47:15 - 01:04:48:11
Speaker 2
Lose weight.
01:04:48:17 - 01:05:16:12
Speaker 1
And how bad that is for your neck. Right. And you move down to the shoulders and, you know, you take this very humeral joint that's just inherently unstable. You know, it's the most mobile joint in the entire body. So therefore it's the least stable joint, full body ball inside joint. But it's really the people think ball socket, the sockets just encapsulating the whole ball and it's they've actually the ratio between the ball and socket is equivalent to a golf ball sitting on a tee.
01:05:16:12 - 01:05:46:08
Speaker 1
Right. So it's just so. Oh, exactly. So that's how small your socket is. You now you have a labrum around that as well, which is not a bone, it's a soft tissue that kind of helps encapsulate the head of the humerus, but that is not bulletproof tissue. You can tear labrum, you can rip labor off and stuff. So because it's such an unstable joints and you take it and you put it in a bad position by having tight lats airplane through internal rotation, then you add on thousands of reps of overhead activity.
01:05:46:17 - 01:06:07:11
Speaker 1
You're going to irritate and stuff eventually potentially. Harrison Stuff, right. So that that's one of the first things we look at in sort of patients is what are their possibly for head and shoulders policies. In fact, we're starting they're going to fix that, obviously mid back issues just from before bed and then and then, you know, the whole spines, one one unit, right?
01:06:07:11 - 01:06:27:00
Speaker 1
So if the mid back is way forward, that's got to make up for it. So a lot of times they're low back, becomes excessively backward bent, right? We all naturally have some backward meaning in our lumbar spine and or low backs that we get totally excessive, more doses, excessive, backward bent, which then puts pressure on some of the elements in our lumbar spine and great lubrication.
01:06:27:00 - 01:06:34:21
Speaker 1
So as you can tell, I mean, just posture alone because a whole host of problems that it's important to keep in mind when you're when you're working on mobility.
01:06:35:12 - 01:06:57:07
Speaker 4
You had to follow Kevin's point up to is we want to think of your shoulder blade and your shoulder is one complex. So a lot of people think, oh, shoulder pathology is associated with the ball in the socket, but it's actually a little bit more dynamic than that. The relationship between how your shoulder blade moves because that's what moves the socket and the ball in space is vital too.
01:06:57:13 - 01:07:24:09
Speaker 4
So when you have these sort of adaptive changes where you get this sort of curvature of your shoulder blade forward where you're actually doing and you can do this as an experiment like you're actually reducing your capacity to get overhead, frankly. And so when we think about range of motion, over average motion, 180 degrees, 120 of that comes from the ball in the socket.
01:07:24:15 - 01:07:50:10
Speaker 4
The remaining 60 is how your shoulder blade moves relative to your sort of rib cage. And so that sort of it's like the scapula thoracic motion is vital. And if you're in a sort of that climbers position reaching overhead, you're losing a third of your motion potentially and relying much more on your glenohumeral joint than your overall shoulder complex.
01:07:50:19 - 01:08:19:01
Speaker 4
So, you know, there's some force coupling issues that we see quite a bit lower trapezius matchups. Those things are grossly undertrained relative to like into your deltoid biceps, the things that make up that overall glenohumeral complex. So if you don't address those muscular imbalances, you're going to be right for any any kind of glenohumeral pathology. Kevin talks about a slop lesion, which is, you know, your labrum tears.
01:08:19:15 - 01:08:57:23
Speaker 4
You're also going to see impingement style things for overhead athletes that's quite common which are rotator cuff tendinitis is things along that line that are just as debilitating. And then if you're reaching for an overhead move or anything like that repetitively over many pitches, like you're just not going to be as successful and your performance will suffer and you'll be unsure why, since a lot of people who are in climbing community are really fit, but they definitely have some significant sort of biomechanical faults, tend to put them in a position for repetitive strain injuries or any general injuries.
01:08:58:06 - 01:09:00:17
Speaker 1
So what are some basic exercises?
01:09:00:20 - 01:09:01:22
Speaker 3
Simple Basic.
01:09:01:22 - 01:09:06:08
Speaker 1
Exercises somebody do can do to fix this kind of pronation is actually.
01:09:08:07 - 01:09:20:04
Speaker 4
You know, Kevin, I'm going to defer to Kevin here. He's like a guardian textbook. I'm really like going back. You're really enjoying this. Probably more so than you guys are in the sports therapist.
01:09:20:04 - 01:09:21:16
Speaker 2
This is like, Oh.
01:09:22:10 - 01:09:48:11
Speaker 1
I'm blushing. Good thing is a podcast now. I mean, my first go to is is to get their mid back and start extending right leg extension is going backwards right like think about pushing your shoulders back you get to your hips that's extension and the trick is to extend your mid back to your lower back. All right. Like we talked about, if you have an excessively for bent mid back, your low backs are getting a lot of extensions.
01:09:48:11 - 01:10:06:15
Speaker 1
So in other words that long story short get your medical training on my first go TOS is is take a foam roller put it perpendicular really across your spine cross a level of shoulder blades when you're laying on your back, your boots on the ground. And these are bent your flat on the table. Right. I the picture here hands behind your head.
01:10:06:15 - 01:10:24:14
Speaker 1
You can argue back over that thing. Yeah. It's like it's like when you used to be in elementary school, you lean back over your chair and your back to right. Like that same kind of move is just I give that to probably 80% of my people. Right. That's a good way to go. Like the what the rest explained is to extend.
01:10:24:14 - 01:10:46:18
Speaker 1
It also needs to rotate. Right. So the other thing I'll go I'll go to after the foam rolling is putting someone in water, all fours sit all the way back on their heels to their butts on the heels, but one forearm flat on the table in front of them all. Second child pose right put the other hand up kind of behind their lower back and then whatever hands that we have to go back there rotate not shoulder towards the ceiling.
01:10:46:18 - 01:11:07:16
Speaker 1
Yeah, right. That's going to get a little extension a little back then rest time is also going to rotate the thrusts. One right. And there's like a whole library of thoracic mobility drills that you could Google, you could YouTube. There's going to be there's going to be a ton more you can do. But I think an thing for climbers especially is you got to have extension.
01:11:07:16 - 01:11:19:07
Speaker 1
You also have a rotation because you guys are turning and reaching, you know, and if you can extend but you can't rotate, you're missing part of the part of the puzzle. So finding some drills that rotate as well as anything is going to be important.
01:11:19:20 - 01:11:38:00
Speaker 4
From a strengthening standpoint. I like to use the exercise ball and know basically put the exercise. So I had the patient lie on it, basically chest on the ball. The ball would roll basically to your sternum and then can do a little bit of thoracic extension. So you want to get into sort of a plank position on the ball.
01:11:38:07 - 01:12:02:16
Speaker 4
You can extend a little bit into the thoracic extension and then it's just working. The scapular. So basically they call them itis and YS and sort of working my way through that motion from a neuroplasticity standpoint, it's not necessarily that they're they're weak, but they may not activate it appropriately. So my my prescriptions are typically like four sets for one minute.
01:12:02:16 - 01:12:17:07
Speaker 4
And that's what we've shown to be able to reconnect that muscular neuro sort of unit and build that strength and foundational so that the rotation and the stretching and then layering some of this strengthening.
01:12:17:22 - 01:12:22:21
Speaker 1
Yeah. You always want to follow up any kind of passive stretches with with active stuff like MATTHEWS about.
01:12:23:14 - 01:12:58:17
Speaker 3
It seems like a lot of the fixes to these problems are focused around the reconditioning of these overuse muscles to kind of get them in a in a more proper alignment. My my personal understanding for this is more of like a lack of use of of the pushing muscles. So the anterior delt chest, the upper chest and the triceps, how much of that do you do you find like if someone were to start working those muscles like because it to me, like these people have big backs, they're strong, you know, they have very muscular backs.
01:12:59:00 - 01:13:28:08
Speaker 3
But it almost seems like because their chest is so small and their interior delts are so small, that it's like growing forward and there's no balance in the front to keep it aligned. It's almost like a lack the lack of material in the front part of the body. Does that hold true to any sort of science? Or and would would focusing on more movements help rebalance their their movement patterns and their actual anatomy?
01:13:29:07 - 01:13:50:11
Speaker 1
You know, I'd be that's a good question. You know, and I would hesitate a little bit to give people that are already in this internally rotated forward head posture, a lot of pushing activities off right off the bat, because when your shoulder gently rotated around and forward like that, your pecs are going to be short already. Right. They might not be strong in this case like you're talking about.
01:13:50:11 - 01:14:12:14
Speaker 1
We're going to be short. And so I think the first step is fixing the posture by getting people up a nice tall posture, working on external rotators like your post, your rotator cuff instead of your internal rotators such as your last and your pants. Once you get that fixed, then I think approaching more of a pushing program with it would be fine.
01:14:12:19 - 01:14:33:12
Speaker 1
It would be totally fine. It might not be, you know, the number one thing climbers need to do to get better at climbing and to get stronger and more functional. But as far as having some balance, just a normal typical life. Yes, but I think the key there, though, is fixing the portion first before you start cranking on the pushing muscles and.
01:14:33:12 - 01:14:58:22
Speaker 4
I tell people this a lot of times you're not you don't get injured because the muscle that hurts is the weak part of your chin. Right. Like because I have a shoulder issue or some kind of tendinitis or musculoskeletal issue, you know, in your wrist or something like that, like that's more because you rely on it much more than that's a faulty tissue.
01:14:59:05 - 01:15:23:21
Speaker 4
Does that make sense, especially in a repetitive sort of condition? So when we have that and we talked a little bit about like being a hot situation or an acute situation, right? Like we can't do much with that tendon, but we can work everything around it. And that's where if we can work the muscles around it, we can actually unload that specific pathology in way that you can still function.
01:15:23:21 - 01:15:59:12
Speaker 4
And then ultimately that's what prevents reoccurrence. So if we just address the acute issue of acute pathology without looking at the overall scope and you can make an argument from a standpoint of, okay, you want to do opposite and agnostic muscle or antagonistic muscles, excuse me. In the value of that, you can make an argument of that from a physical therapy standpoint is that's something that we necessarily focus on, probably not from a strengthening standpoint, but more from a sort of anatomical standpoint, like restoring normal length of some tissues that we know or adaptively shortens, certainly.
01:15:59:12 - 01:16:07:11
Speaker 4
But you still have to work around the issue to look at why you're susceptible to a repetitive injury. Does that make sense?
01:16:09:05 - 01:16:31:09
Speaker 3
Yeah, and I think that the point that Kevin brought up that really hit home for me and why this my particular analysis is incorrect is because the chest muscle is short. That's like it's short. It's it's in a shorter position. And so strengthening it is going to make it contract more. You know, you haven't given it the length and the proper positioning to activate properly.
01:16:31:09 - 01:16:45:20
Speaker 3
And so that right there makes a lot of sense to me in terms of correcting the posture, correcting the layout of of the back before you start strengthening the front because you're just going to cause it to shrink more if you're trying to strengthen a shortened muscle.
01:16:46:13 - 01:17:07:20
Speaker 4
But then you also have to consider like concentric versus eccentric. If you say, okay, I want to strengthen my chest muscles, am I going to do push ups a lot of push ups? No, because that would be concentric adaptively short of exercise, which you could do, and eccentric potentially push up, which would then restore more sort of normalcy in the length of that actual muscle.
01:17:08:01 - 01:17:21:04
Speaker 4
And that has great value right. And so that's something that you have to differentiate that two between and it just again, it adds its richness to potentially your recovery or injury prevention before you even get injured.
01:17:22:14 - 01:17:42:08
Speaker 1
And that's going to add up to off that. Something interesting that I've learned recently. As you know, we take tight muscles, short muscles like the pec, for example, in this situation, and we stretch them right. And that's going to cause this muscle slowly starting long, the muscle fibers meaning longer, longer and, longer and eventually getting good posture. And that's all good.
01:17:42:08 - 01:18:02:10
Speaker 1
I mean, that's well proven over time in research that works. But when you're stretching muscles, you actually get like a transient decrease in strength muscle messages for a short amount of time. They're weaker and they're actually more susceptible to injury. If you, for example, go to a big pec stretch on a foam roller, then you go rep your PR bench press.
01:18:02:10 - 01:18:27:20
Speaker 1
You got an increased risk of injury, that thing. So one thing that I've learned is if you stretch like Matthew somewhat eccentrically, right, so eccentric essentially are contracting the muscle. But if you're contracting, it was lengthening. So think of like a lowering portion of your bicep curl or you're doing a catchphrase. It's a lowering portion of recoveries. You can actually get the length changes that you want with the stretch, while also strengthening the muscle, same time by doing just the centers right.
01:18:27:20 - 01:18:44:17
Speaker 1
So, you know, for for a, for a pushup example, right. Get up on a, you know, in a pushup position with your hands on two small boxes and get all the way up there and slowly lower yourself all the way down, or you're feeling a pretty big stretch in front of your chest. And then your chest hits the ground, your hands are off the box.
01:18:44:22 - 01:19:08:02
Speaker 1
You kind of roll on your back and sit back up and get back up and do it again. Right. You're kind of avoiding the actual back push back part of it, if that makes sense. You can get the benefit of the stress plus the strength, a loading variation of that. I think is if you get like if you were doing a bench press and you get somebody to spot you, so you only do the eccentric concentric portion, the spotter just pulls the weight up and then you just the load stretched out.
01:19:08:11 - 01:19:10:18
Speaker 1
Thanks, Matt. That's a much better.
01:19:11:19 - 01:19:17:03
Speaker 2
To like rolling up the push up that's.
01:19:17:09 - 01:19:18:02
Speaker 1
Going to stay there.
01:19:18:11 - 01:19:21:05
Speaker 2
What I was going to. Yeah, yeah, that's much good.
01:19:21:05 - 01:19:25:04
Speaker 4
Yeah. I think they call that a negative weight. Weight lifting, right. Like a negative.
01:19:25:04 - 01:20:08:21
Speaker 3
And Negative, yeah. Mm hmm. The last repetitive strain injury that I think I have to cover is the infamous psoas and the front of the hip and the point of how pain can manifest itself in an area in the body that is not actually the source of the problem. And I think so, as does this very sneakily, where a lot of people complain about lower back pain and really tight back pain and they get this this posture, like this or like the booty sticks out and their back is super tight in their abs or distended and that's all related to a tight psoas and people sitting in chairs all the time.
01:20:09:04 - 01:20:25:14
Speaker 3
And you also get this in climbing because you're always lifting your knees up. You're lifting your your your legs up high and that's all activating this so as area so if you guys want to kind of talk a little bit about this particular repetitive strain kind of situation and yeah, that topic.
01:20:27:01 - 01:20:46:06
Speaker 1
Yeah. So as a quick as a quick review, so as is hip flexor muscle, it comes off the lumbar spine every secondary lumbar spine runs straight down and attaches to the very front of your femur that's up by the hip joint. Right. So it's most powerful hip flexor you have. It's a notorious muscle because of the passage and lumbar spine.
01:20:46:06 - 01:21:02:13
Speaker 1
And if it's tight, it pulls on the lumbar spine. You can create lumbar spine issues. So that's actually to answer your second question is the example of when my back hurts. When I do X, Y, Z, we do a full back using your back. That's pretty good. You're so s with type one on your lumbar spine and creating those issues.
01:21:02:17 - 01:21:22:23
Speaker 1
So that's an example of where the issue is. Somewhere the pain is showing up somewhere else, right? But in climbers, you guys are such like you have to get your hips way, way up into a huge flexed position where your knees are up for your chest, especially kind of externally, rotate it off to the side to be flush against the wall.
01:21:23:02 - 01:21:53:12
Speaker 1
That is a ton of hip flexor. And so as activity, so it can manifest it can it can pull on your lumbar spine and create lumbar spine. It can create kind of front of the hip type injury type issues where you kind of infringing your hip joints as well. So it is it takes a good thorough examination to know is that so as tight and treating these issues or is it not doing its job?
01:21:53:19 - 01:22:18:07
Speaker 1
Is it not strong enough? Essentially, it's not doing a job as a stabilizer from the hip and creating other issues. And that's something that you probably are going to need or your doc to really help kind of figure out that specific differentiation of is is a tighter is it just weak but I would say definitely, definitely a muscle that is involved in a lot of hip and low back issues.
01:22:18:12 - 01:22:20:14
Speaker 1
Do you have any recommendations for the release in the SO.
01:22:20:14 - 01:22:20:20
Speaker 3
As.
01:22:21:11 - 01:22:32:08
Speaker 1
A curiosity because like I know I've released myself as I've also had like massage therapists. I know who's done it too, but like it can be really tricky. Love you don't know. Yeah.
01:22:32:17 - 01:22:56:06
Speaker 4
Yeah, yeah, I think so. Just kind of circle back. The idea of referred pain is always a very challenging thing to sort of kind of work your way through, and it can be complicated in your recovery. So again, we go back and describe these hypotheses and with referred pain, you're going to have a number of hypotheses that you're going to have to test and kind of work way through.
01:22:56:06 - 01:23:23:18
Speaker 4
And this is where a differential diagnosis from a musculoskeletal standpoint see a physical therapist, right? Like research indicates we are one of the top professions along with orthopedic surgeons, and we outpace any type of primary care provider in regards to accurate diagnosis is. So we're on par as a profession with orthopedic surgeons and the two of the two those two disciplines alone outpace anybody else.
01:23:23:18 - 01:23:46:08
Speaker 4
So if you go to your primary care and they diagnose you with this, frankly, it's just a guess. And that's not really going to be very specific. So if you take that diagnosis and you go and try and self-treat, the likelihood of you being successful is pretty low, frankly. Now back to sort of releasing the illness so as muscle.
01:23:46:13 - 01:24:15:11
Speaker 4
I mean, the best thing to look up is probably the Tommy stretch, but there's some nuance with that that I found because you can cheat and based on sort of the anatomical positioning of the so if you think on releasing the cells, you may actually just be extending your back, you know, or doing something different. So I try to do that in session and then try and teach them that sort of self, that.
01:24:15:11 - 01:24:18:13
Speaker 4
Thomas Stretch But I don't know, Kevin, if you have any better ideas.
01:24:19:13 - 01:24:41:10
Speaker 1
One that I've given to some people that I, I definitely go over in the clinic multiple times to make sure they're comfortable with it. They know what they're doing because it is a little can be a little sketchy at times is taken with a kettlebell like pretty heavy kettlebell, maybe 20 or £30, turn it upside to the handle is about halfway between that bone on the front of your hip kind of assist.
01:24:41:20 - 01:25:03:10
Speaker 1
Right. Like if you kind of feel the front of your hips on your side and your belly button, you're so as live way down deep underneath all your guts in opposite in that spot. So you take the the handle kettlebell and set it right on top of that and let it sink in slowly and it doesn't feel good.
01:25:03:10 - 01:25:18:16
Speaker 1
But if you get right on top of it, they'll know, you know, because it feels like a massage that's getting in and digging on a really bad muscle. You can also take that leg and just lift your foot up off the ground a tiny bit. And you should see that kettlebell kind of bounce up a little bit because you've just contracted that.
01:25:18:17 - 01:25:36:21
Speaker 1
So as muscle and you see that kind of I'll move, right? And so you can kind of confirm that you're honest, right? The reason I'm a little hesitant with people is that if you're too far medially towards the bellybutton, if you get bladder, you can be on your small nerves, more artery and stuff. Not that you know, unless you have a super full bladder, you might rescue bladder, but other than my irritating.
01:25:37:06 - 01:25:37:15
Speaker 2
Or, you know.
01:25:38:03 - 01:25:43:09
Speaker 1
Super nasty. But I would go still before you do it. I guess is Wednesday.
01:25:43:12 - 01:25:43:21
Speaker 2
Yeah.
01:25:45:02 - 01:25:46:13
Speaker 3
Have you guys heard of this so. Right.
01:25:47:06 - 01:25:56:01
Speaker 1
Yes. Yes, that thing. That's that thing. That's vicious. Looks cool, man. Yeah. Have you guys. I haven't used it. I think Joe Rogan has started something similar.
01:25:56:01 - 01:25:56:19
Speaker 2
To that before.
01:25:58:00 - 01:26:13:15
Speaker 1
Yeah, it's like that two pronged. Like it's like a two pronged thing that you can sit on, right? And like it digs right into you. So as I've heard, I think you like you like like you like lay on your stomach and you like a single hook, but you lean your stomach and you kind of sit at center.
01:26:13:15 - 01:26:20:01
Speaker 1
Right where I was talking about is use your body weight to kind of sink down into it. Yeah. So same idea. Do different position. Yeah. Yeah, I totally.
01:26:24:12 - 01:26:33:16
Speaker 3
Nice Max anything else or you guys anything else for repetitive strain injuries before we move on to covering traumatic climbing injuries.
01:26:34:09 - 01:26:51:05
Speaker 1
One thing I would I mean, this isn't quite like repetitive injury or anything, but maybe just quickly touching on the basis of of properly warming up, you know, like we express it, if you were doing like really heavy loading, you might not want to stretch your muscles beforehand because you're actually in longer eating and increasing that range motion.
01:26:51:05 - 01:27:09:17
Speaker 1
And that's a very specific thing. My understanding, which could be wrong, but I think this works for me, is that generally you want to get your heart rate progressively up, you want to pump synovial fluids in your joints and whatever the area that you're going to be like. Like we could say loading, I guess like for example, fingers and stuff.
01:27:09:23 - 01:27:34:17
Speaker 1
You want to make sure they're really warm to prevent injury or to prevent repetitive strain. I'm just wondering if you guys maybe touch base. I'm just like your thought process of warming up really quickly. Yeah, I'm not sure how it pertains with rock climbers in particular, but I remember like some research study that looked at dynamic warmup, which is like what you're talking about, where you're moving your sweatin your lunge, twisting your inchworm, and you're getting you're just moving essentially jumping jacks.
01:27:34:21 - 01:28:01:00
Speaker 1
It doesn't really matter, right? Compared to either no warm up, just static stretching and it reduces injury rates by like 33%. Like a third. Yeah, just being a dynamic warmup instead of these traditional tops, the long gone are the days where before soccer practice resuming touch toes the 30 seconds. Yeah right. So so you're absolutely right. I mean we've got a pretty structured dynamic warm up in the clinic that I give people and I give it to them to take home before they do their stuff.
01:28:01:00 - 01:28:18:20
Speaker 1
And and essentially the key is you want to move in all three points, one before and backward side to side and rotational. You want to get your heart rate up. You want to be pretty much sweating, you know, before you're actually getting on the wall, go climb. And like you said, you know, your fluid in the joints is going to food joints.
01:28:18:20 - 01:28:29:03
Speaker 1
Your muscles prior to the nervous system can primed. Everything's going to be ready to go and your chance of injury is going to your performance is going to go up and your chance of injury is going to go way down. Yeah, totally.
01:28:29:03 - 01:28:49:03
Speaker 4
I don't have a specific sort of exercise protocol, but I would sort of confirm all of that dynamic warmup stuff I think for climbers are probably the biggest concern would be those eight to a48 injuries. So you really want to make sure that your hands are really warmed up because you can do a really aggressive load.
01:28:49:03 - 01:28:50:18
Speaker 3
Actually, I have a do you.
01:28:50:18 - 01:28:51:17
Speaker 4
So yeah. I mean.
01:28:52:21 - 01:29:20:08
Speaker 3
You take your hands on you and you flick and you start down low underneath your heart and then you keep flicking, keep flicking, raise them above your head and then bring it back down again. And then you can, once you like a little bit of a pump your forearms, you can then start to flick individual fingers. So you start to flick just your then your ring fingers on your middle fingers, then your index fingers, and then you go back to doing all four again.
01:29:20:13 - 01:29:42:08
Speaker 3
And your goal is to literally get your forearms pumped and then you let him rest again and yeah, climb and. That's been my, my big protocol for warming up my hands, especially on a cold day because I have popped both ring finger poles before from jumping on a 511 in the cold with no warm up. And it was like one of the first moves off the ground.
01:29:42:21 - 01:29:43:10
Speaker 3
It was gone.
01:29:43:13 - 01:30:11:02
Speaker 4
Yeah, because this is another one that I found to be very very interesting. So I love this statistic. So there's a2a4 pulleys. They're designed to withstand 400 meters of force. Right. But a crib alone can generate 450 Newtons. So you are already like if you are, just go full crib, like already about 40% over structurally what they're designed to handle.
01:30:11:14 - 01:30:35:18
Speaker 4
That's like that's an insane statistic to me and I can't believe it doesn't happen more often. Rightfully so. Like the beginner climber who is so, so pool heavy versus footwork like I like I couldn't imagine like I don't know how how I made it through like a bouldering session as a beginner and I didn't pop my tendons like I just looking at that statistic blew my mind.
01:30:35:23 - 01:30:46:18
Speaker 1
I think it'd be specific edges and actually like crimping is specific with your thumbs going over. So but as a generalization, I do I do agree with you. And the reason I wanted to bring up this up is like, you know.
01:30:47:00 - 01:30:47:12
Speaker 3
Sometimes I.
01:30:47:12 - 01:31:04:19
Speaker 1
Like going to the gym and and not to be too judgmental but it's pretty it's pretty interesting to people watch sometimes sounds a little creepy or something but like see people's forms or how they work out or what they do. And this application could go to a climbing gym, it can go to a rec center or like a fitness facility or whatever.
01:31:04:19 - 01:31:25:08
Speaker 1
And you can generally kind of tell when people have like a pretty good understanding of physiology and injury prevention in the way they operate, whereas like the majority, like in my experience, I'd say about 90 to 95% of people just come in zero warm up. They either jump right on the climbing wall or they bench press right or do whatever.
01:31:25:12 - 01:31:36:08
Speaker 1
There's no stability work involved. There's no warm up. And and it's just like a leading to like poor motor mechanics, probably injury and all these things. So yeah, I just thought we should touch on that.
01:31:37:10 - 01:31:38:20
Speaker 4
They are no real powerful stuff.
01:31:39:01 - 01:31:55:04
Speaker 1
Very much so. And I mean, those, those guys can get away with it for a while. Right. But these are they're probably treating a lot of these little micro traumas that are getting closer and closer to that macro trauma. Right. So, yeah, that's why it's tough sometimes because people don't realize that what they're doing is good for them.
01:31:55:09 - 01:32:07:07
Speaker 1
Right. And awesome. And they go and do that exact same thing for the 50th time. And that's the one that doesn't then, you know, they look at you and they're like, What do I do I do that stuff all the time? Why did this one hurt me? You know, it was has been in the works for a while.
01:32:08:03 - 01:32:16:23
Speaker 4
Yeah, yeah. But the frost is real. Like, everybody's excited that they were to do these things. And, like, who wants to do finger?
01:32:16:23 - 01:32:29:08
Speaker 2
Like the circle? But yeah.
01:32:29:08 - 01:32:35:08
Speaker 4
I mean, it's true. Everything that Kevin alludes to, totally true. Gives us a business.
01:32:37:00 - 01:32:38:00
Speaker 1
Yeah, well, I think that's great.
01:32:38:00 - 01:32:38:09
Speaker 3
Place to.
01:32:38:09 - 01:32:42:08
Speaker 1
Kind of move on and maybe if we could just touch on that traumatic injuries.
01:32:42:08 - 01:33:06:15
Speaker 3
Here, you know? So Matt, I'm looking at your your little sheet here on on traumatic recovery and I feel like we've you know, we are coming close to the two hour mark. So I think times look limited. But I think, you know, we have covered a lot of of stuff kind of in terms of the recovery and and a lot of this stuff in terms of the repetition of strain injuries and preventing that stuff kind of transfers over.
01:33:06:15 - 01:33:27:00
Speaker 3
So whatever you have specifically for traumatic injuries that you'd like to cover, I'd love to hear it. And then I think we talked a little bit about return to sport goals. But yeah, just kind of rolling into that and kind of closing off the entire conversation. Yeah, ending with kind of giving people a vision for how to return by giving them hope if they currently are doing.
01:33:27:01 - 01:33:30:07
Speaker 2
Yeah, yeah, sure, sure. Yeah.
01:33:30:14 - 01:33:52:03
Speaker 4
You'll be all right. I think I think most important that I added in there were again some statistics and I don't want to just live in the statistical world, but I think it provides perspective. So they estimate call it all estimated like 10 to 39% of all injuries are from a fall and 43% of those fall injuries result in surgical interventions.
01:33:53:10 - 01:34:23:01
Speaker 4
And finally, 20% of those injuries are ankle contusion fractures who and so yeah. Who goes through here for you guys. And I think the most important thing from a standpoint of maybe some of your decision making is that you get to the six meter or 20 foot mark and your odds of fracture by fall are two and a half times and a sprain is three, three and a half, three, almost four times more.
01:34:23:08 - 01:34:38:20
Speaker 4
So if you're out there tried climbing and you don't want to necessarily be thinking, oh, I've got to prevent myself from an ankle fracture, it's helpful to maybe put in, you know, that Jesus, not before the six meter or 20, 20 foot fall.
01:34:39:12 - 01:34:49:18
Speaker 2
Right? Yeah. I think that you probably the Jesus Matthew Moses not just keep going ascetic may have know you.
01:34:49:18 - 01:34:50:15
Speaker 1
Do this all day.
01:34:50:15 - 01:34:54:21
Speaker 2
For you got the for the letter.
01:34:54:21 - 01:34:55:09
Speaker 4
They called it.
01:34:57:06 - 01:35:02:07
Speaker 2
Jesus. Yeah I knew. I think that's totally right. It's like.
01:35:02:23 - 01:35:03:16
Speaker 1
A weird drill.
01:35:03:16 - 01:35:08:05
Speaker 2
Man. Good luck to.
01:35:08:08 - 01:35:27:21
Speaker 4
You guys out there. It's like that's the one that I'll save you from what I think is a factor to fall. Basically when you're building an anchor. But if it's a ground fall, it's the same concept. Like maybe just consider those first six meters to be valuable in a decision making process. So I think that would be probably the most important thing.
01:35:27:21 - 01:35:50:12
Speaker 4
And then Carl's alluded to this, some previous ones, he made a sound decision because he could in regards to surgeon skill. So I think from a standpoint of a physical therapy, from a physical therapy recovery, traumatic surgical injuries or sort of traumatic nonsurgical injuries are really kind of paint by numbers, right? So it's like if it's weak, we strengthen it.
01:35:50:12 - 01:36:19:13
Speaker 4
If it's time, we stretch it and you sort of restore yourself through just activity. Surgeon skill plays a huge role, though, because they're the ones, you know, they're based on conversations I've had with my surgical surgeon friends. Like their objective is to restore sort of anatomy, and so they're inserting screws and rods and all of these things to make it so that it's anatomically similar to what it was pre injury.
01:36:20:02 - 01:36:43:07
Speaker 4
And that's all surgeon skill. And at the end of the day, as a physical therapist, we have a pretty easy if the surgeon did a great job. And so making that decision, if you're capable of to hold off and get a surgeon that you know is skilled and is familiar with, the procedures, just sets you up perfectly for a much better recovery than that.
01:36:43:10 - 01:37:07:03
Speaker 4
And then patients I think patients is the number one struggle for most people, especially active people coming off a traumatic injury. It just takes forever and the way I sort of tell people to manage their day is I said it takes twice as long to do half as much. So you're 25% efficient from where you were know, the day of the injury.
01:37:07:12 - 01:37:32:13
Speaker 4
And that just kind of gives people a structure and gives them space to forgive themselves for maybe not doing everything that they thought they could because there's so many factors that are going on in an active healing process. I think it is it is a bank account. And like you start your bank account at 100 and just like $35 of that bank account is like breathing, digesting, you know, normal stuff.
01:37:33:02 - 01:38:07:14
Speaker 4
And then so you're already at like $65 for the day and then you're healing is another $25. So you're left with $40 to spend the rest of your day. Like, how do you spend that to feel like you're accomplished and you're sort of in it? Does that make sense? Yeah. So and then that sort of kind of how I shepherd people through this recovery and it's universal in their way to spend their money or to feel efficient is a lot different across the spectrum.
01:38:07:14 - 01:38:09:19
Speaker 4
So it's somewhat applicable in. My mind.
01:38:10:13 - 01:38:20:06
Speaker 1
Totally. Yeah. Well, I think then, you know, I think we can go on to this next topic here, which is, you know, like I said, getting back to sport is the fun part, right?
01:38:21:11 - 01:38:21:18
Speaker 2
Yeah.
01:38:22:07 - 01:38:23:12
Speaker 1
Yeah. That's what it's all about.
01:38:23:22 - 01:38:26:03
Speaker 2
We all. Yeah.
01:38:26:15 - 01:38:45:22
Speaker 4
Yeah. This is all Kevin and I am going to sit back and learn, so I'm quite interested. I mean, Kevin, don't be afraid. Now, you guys like this, this sport certification that is, like, really hard to get. He's doing this fellowship. This is like, this is the Met, so I'll see if I can join.
01:38:45:22 - 01:39:19:05
Speaker 1
Well, I mean, I've I've learned a ton from my job up in Spokane working hand-in-hand with the strength visiting coaches. You know, those guys are so good at what they do and definitely some crossover between what we do and what they do and working hard. I mean, that's just like the bread and butter, you know. So it's really fun to to get people from an acute injury back to where they were work for the training conditioning coaches about getting them now maybe a little stronger, maybe a little more active than they once were running a little further down, a little bit more sports stuff and then watching it over to them and watching them to
01:39:19:07 - 01:39:36:09
Speaker 1
take in runs. But yeah, I mean, this is a big part of my passion in the world. And I think a couple of things to really consider from, from really the beginning is continuing to stay active in other ways, you know, working the other side, you know, if you broke your right foot, do calories on your left foot.
01:39:36:09 - 01:39:53:10
Speaker 1
There's actually this cross education stuff where you can workout one side. The other side actually gets stronger, right? And it's all neurological basis. The muscles are actually in stronger reverses and learn how to fire things harder. Right. And then as you progress more and more into being active and getting back to your sport a little bit, you're not quite ready to go.
01:39:53:16 - 01:40:20:00
Speaker 1
You know, what I always tell people is like, you just got you got to prove it. You know, you got to prove we're not going to ever sitting on the table and exercising on the table and then say, okay, you're good to go, go for it. You know, like it's a very progressive, slow at times stepwise progression to get people back to what they want to do a little by little by little, as far as like specific, you know, protocols.
01:40:20:14 - 01:40:47:07
Speaker 1
Most of these are designed for, you know, soccer players, baseball players, runners, kind of the your traditional sports type people. There's not time. There's really none that are specific for rock climbing. But going over to a couple classic lower extremity protocols for a return to sport, you know, first thing you need is you need a quiet joint. The joint that's got no inflammation, got zero pain at rest.
01:40:47:07 - 01:41:09:16
Speaker 1
Or with any of the rehab you've already done like that, usually the pain changes the way you move. If you're trying to jump and be active through pain, you're more susceptible for injury. But that's baseline, right? Your strength needs to be symmetrical. And some of that's subjective because we were testing with our hands. Although I would suggest if you're a high level athlete, you're working with the the PD should have some sort of measurable way to measure your strength.
01:41:09:18 - 01:41:25:09
Speaker 1
Right. A lot of it uses little brain skills that you can rig up onto a table, you know, and you're pushing this are you can feel are pulling as hard to do and actually gives you a number, right. So you need to have these numbers of output of strength that are totally even from side to side, not 90%.
01:41:25:09 - 01:41:44:21
Speaker 1
Not 95%, 100%. It's not stronger. And then you get certain more the specific more kind of exciting stuff. So for lower extremity, one of the things we do, you know, after injury, you're going to lose a lot of power powers, how fast you can move and a fast horse. So hopping jumping is a good way to measure power.
01:41:45:03 - 01:42:08:00
Speaker 1
And the return to sports protocol for those from the injuries are these three hop tests. There's a single leg hop test for distance. We jump once legs are you can you've got to stick the landing right you take the best of three compare that on right and left it's got to be some say letters you will say like 9090 3% is good I'm more of like you got to be 100%.
01:42:08:10 - 01:42:24:10
Speaker 1
You got to be right there. So that's one thing about the next one is a triple hop. You're on one leg, you're having three times right in row consecutive. Can you stick that last landing that this pair right left? The third one is the crossover triple hop, where you go from one side of a tape measure on the ground or a piece of tape on the ground.
01:42:24:18 - 01:42:33:05
Speaker 1
You've crossed over to one side of the piece to cross right back over to the original side of the cross, back over that last side again, measure right and left. Right. Pretty straightforward. Go ahead.
01:42:33:07 - 01:42:46:08
Speaker 4
Kevin. I have a quick question with that. Are you taking on the triple hops? Are you taking is it going to be symmetrical for every hop or are you more concerned about the end game, like the total?
01:42:46:10 - 01:42:46:18
Speaker 1
Yes.
01:42:46:19 - 01:42:55:07
Speaker 4
Then so even if there's even if there's asymmetries in the middle hop, we're still all right with that return to sports to the end game.
01:42:55:07 - 01:43:18:14
Speaker 1
Absolutely. Yes. We're taking the very last final measurement of where they land. Right. And then one that I'll add sometimes to, especially if they're in a sport that's a lot of lateral movements is side like lateral or facing sideways and then jumping sideways. Right. And that same thing is measure the distance. One thing that I think that, you know, it's pretty easy to get on through that protocol, you know, and to see what their numbers say and calculate the numbers, what percentage threat.
01:43:18:23 - 01:43:41:17
Speaker 1
But another thing I really pay attention to is how they're moving in our landing and how they're jumping you know, there's these you see people that don't quite have the best strength on the leg. And when they land, they land really stiff leg. We call it like ligament dominance. We rely on your ligaments on the door. We watched that load from you landing compared to someone that lands.
01:43:41:17 - 01:44:03:12
Speaker 1
And they're a big shock absorber. You see them in their foot, hits the ground, their knees bend, their hip bends, you know, they stay tall. And this big, huge shock absorber absorbs all that force and keep popping back up. And so that's a little bit more of a subjective art of it. A little bit is is looking at how somebody moves, making sure they're using their muscles properly and they're landing properly with something in location for the injury.
01:44:03:15 - 01:44:23:11
Speaker 1
Right. And point the iPhone and doing a slo mo video is sweet resorts out in the clinic right like we didn't have that ten years ago and now we've got such a huge advance out. So that's the new standard, launching new protocols, obviously. You know, you can tailor some of the runner, you do more line stuff and so on, so forth.
01:44:23:11 - 01:44:52:13
Speaker 1
But for the purpose of this podcast coverage, family protocols are almost all geared towards throwers in the literature, right? Because that's of huge percent of population of returning to sport. Testing is in throwers. I think the one that really applies to the climbers, though, is this modified test where you can imagine land on your back under a sniff bar or even the rack and you're reaching your hand straight up or just feeling the bars just like a couple inches past your fingertips above your fingers.
01:44:53:16 - 01:45:08:12
Speaker 1
And guys will put their heels up on about an eight inch box. Girls will put the boxes behind the knees a little easier. Right. And you reach up and grab the bar. So you're on your back around the bar. Your point the bar until your upper arms are parallel to the ground, right? Not all the way bar the chest.
01:45:08:12 - 01:45:31:19
Speaker 1
A little short of that. And you're going through reps, right? You're trying to get as many reps as you can't before you break form or you can't let yourself up. And there's been some literature done that kind of has normalized numbers on what you should be achieving. And it's kind of interesting for men, if you're between 18 to 22, you should be getting 11 of those reps trimming between 23 and 27.
01:45:31:19 - 01:45:49:04
Speaker 1
You should be getting 12, 28 and 32, you should be getting nine. So start to drop a little bit, 33 and 37. You should be getting up to, which is blowing the younger group out of the water. So, so apparently the 33 and 37, you're supposed to be a lot stronger than where you're between 18 and 27, which I thought was interesting.
01:45:49:04 - 01:45:55:14
Speaker 1
Given all I can do, you probably like 50 or 60.
01:45:55:14 - 01:45:57:22
Speaker 2
I'm just you two.
01:45:59:00 - 01:46:04:02
Speaker 1
That's right. I don't know. I don't know if you heard me counting, but I did over a thousand.
01:46:04:02 - 01:46:06:04
Speaker 4
You're like in a thousand?
01:46:06:04 - 01:46:10:11
Speaker 2
3000 now.
01:46:10:21 - 01:46:14:07
Speaker 1
It's been a while since I put myself through that one, and probably for good reason.
01:46:14:15 - 01:46:18:15
Speaker 2
I was probably but.
01:46:18:20 - 01:46:39:19
Speaker 1
Girls 18 and 22. So we get in for 23 to 27 to be getting 4.5. They're 28 to 35. And you can look these numbers up if you wanted to. But I mean, that's from the upper extremity stuff. No, so much of the testing is throwing, which is going forward, right? You're accelerating your arm, whereas climbing you've got to pull.
01:46:39:22 - 01:46:57:15
Speaker 1
Right. And so much of point support. So I think that modified test is going to be probably the best return to sport test for climbers on top of all the normal range motion strength stuff that we talked about. So this was your you're lying down feet on a box and then you're you're pulling the bar chest to your chest, right?
01:46:57:15 - 01:47:02:05
Speaker 1
Yeah. Okay. Gotcha. So there's a whole bunch of core posterior chain engagement and then pulling in them.
01:47:02:19 - 01:47:15:16
Speaker 4
Yes, that's quite common. That's common in the personal training world. Right. Like, you know, performance, kinesiology, stuff like those. Do they fully believe? I've seen it just personally, I don't know anything about it.
01:47:15:16 - 01:47:32:03
Speaker 1
But yeah, you know, it's an easy thing to measure, you know, because you're measuring reps, but it's a lot easier than pullups. You know, some people can't do more than one or two. So it's hard to measure. Change does it's like, okay, you want to do it at two and a half or 2 to 3, whereas this is you're going from 11 to 17, you know.
01:47:32:10 - 01:47:59:23
Speaker 1
So I think that this is a little bit more useful in the clinic for sure. There's a there's a really cool ice climbing progression that is exercise similar to that, and it starts off with like a progression of like, you know, like you're like holding tracks, handles and you're doing a similar pull with your legs. 90 And this progression will go all the way to having a nice two on one hand and both legs on an exercise ball.
01:48:00:02 - 01:48:18:03
Speaker 1
And then you're pulling with, with full rotation all the way to top. And then that kind of progressed to like having weight as well. So it's a really, really cool exercise. I've done it a whole bunch of programs, but it's, it's a lot like it. It really I mean, you could, you could just kind of like you could apply that stuff to yourself, right?
01:48:18:03 - 01:48:34:05
Speaker 1
Like you can take that and say, okay, I'm going to go with one arm and see how many I can do when I'm pulling with one arm second for the other. And it should be 100% equal. Yeah. And that's like some of these other ones are like taking a medicine ball, sitting in a long sitting position, taking this ball just shot, put in as hard as you can on one side and this shot.
01:48:34:05 - 01:48:56:04
Speaker 1
But on the other side, it's got to be the same, even if you know you're non-dominant, right? So it's a symmetry, right? Symmetry and and a slow back to full activity. Yeah. And confidence, symmetry, slow progression and measurable obtainable like goals and standards to actually certify, know like some of these things. I don't know if ambiguous would be the right word or something.
01:48:56:04 - 01:49:16:10
Speaker 1
Like obviously they pertain a lot more to like specific sports, but the principle still applied about like tissue health, body health, strength, symmetry. Right. And just also having this that you're removing guessing out of the equation, right? Rather just being like, oh, well, the surgeon told me it's been six months and I feel okay. So like I'm going to go back to play soccer or you know, I'm going to go back to climbing.
01:49:16:14 - 01:49:32:07
Speaker 1
It's like, well, you know, like if you have a baseline of where you were at before and now you had can do half is less. You know you can you can you can you can guess that most likely you're not fully healed and you're actually weaker, which means you're more injury problem, right.
01:49:32:19 - 01:50:02:23
Speaker 4
Yeah. And there are some yeah, there are a lot of consumer products. So Kevin alluded to those biomechanical apps. They're great and I've a lot of remote training with people where they'll send me videos and I can just look and add angles to it and you can see the asymmetry and then you can put numbers to it and it really reinforces and there's a lot of evidence out there about visual reinforcement being a very powerful motor control and learning tool.
01:50:03:06 - 01:50:13:21
Speaker 4
And people can change it remotely. Like you can change your running style on a treadmill remotely based on this sort app feedback. It's really neat stuff to see.
01:50:14:11 - 01:50:15:03
Speaker 1
Super cool.
01:50:15:06 - 01:50:41:04
Speaker 3
So I guess the question I have with this topic is, is return to sport and we're throwing out some metrics and we're thrown out these numbers. Is this more of like because to me those numbers aren't like, okay, I hit these numbers, now I can play my sport again. It's more of I hit these numbers now I can assume I'm I'm back to quote unquote normal and I can assume I'm out of some sort of danger.
01:50:41:05 - 01:50:41:10
Speaker 3
Right.
01:50:41:10 - 01:51:01:18
Speaker 1
So it's comparing you to people of your gender in your age group, right? So it's normative data. It's not symmetrical data. It's not you know, it's not comparing you to your old self, right? So take it so it's useful, but it's not everything. Take it with a grain of salt like Max is talking about. You've got to take your history into it, your prior performance into it.
01:51:02:00 - 01:51:09:16
Speaker 1
Where are you at from 0 to 100% based on what you were before your injury and use that as a guide and how hard to push yourself as you get back to it.
01:51:10:04 - 01:51:23:06
Speaker 3
But someone could potentially start climbing before they can do whatever number of those back else. It's not like a it's not a barrier to reach before you can return to sport. It's more of just a a comparison.
01:51:23:06 - 01:51:43:00
Speaker 1
Right, exactly. That's what kind of you know, you got to prove it, right? You got to get them on the wall and start climbing. And he might do the easiest pitch and you're doing it for 5 minutes. And that's they want to see how you respond. So if your saw like like not talking earlier now, one hour from now, tomorrow and then from there, let's do 10 minutes and then move on to the harder ones.
01:51:43:00 - 01:52:01:11
Speaker 1
Go 15, 20 minutes. And this is really kind of it's really logical. Like there's we're not recreating anything. It's really kind of boring. I explain it to people. They're like, Oh, well, you know, like that's the most eligible thing possible, but you just have to make sure and follow through with it. Like, that's the thing. You'll, you'll go through times where you'll be like, okay, I'm midway through this progression.
01:52:01:11 - 01:52:14:05
Speaker 1
I'm doing this moderate climb and I'm feeling really good. I'm going to go for me and I'm going to go for the hardest climb in the gym. And like, you've got to rein yourself back a little bit and just take it in that really stepwise progression. Make sure you prove it every step of the way.
01:52:15:11 - 01:52:42:22
Speaker 4
Yeah. Kyle, these protocols are not predictive, right? They don't say, Oh, because you can do these things now you're going to be good again, right? Like there is a big space between being able to perform and performing. And so that's a tough thing. And you can also you can do things, but suboptimal. So when you think about climber specifically, what's great is it's a graded activity, right?
01:52:43:00 - 01:53:09:14
Speaker 4
Like you're a 513 climber at your max, right? So could you be a58 top rocker during the active recovery process? Sure. I mean, you can speak of that. You even though we didn't reach these benchmarks and we may not get to them any time soon, I can still go back and perform your sport, but there could be potential consequences that need to be discussed between you and your provider or just with you and yourself.
01:53:10:02 - 01:53:10:07
Speaker 2
Mm.
01:53:11:00 - 01:53:27:21
Speaker 3
I guess I just wanted to add some context to our topic, which is return to sport and these exercises and benchmarks that you were kind of laying out so that someone might not assume, like, okay, I write these before I even asked myself, yeah, that was a really it was all I was trying to add context to. But yeah.
01:53:27:21 - 01:53:30:19
Speaker 3
Kevin, you said there was something you were about to add.
01:53:30:19 - 01:53:51:08
Speaker 1
Yeah, yeah. One of the final components I'll give to somebody before totally releasing them back to their activity is what we call the fear of what is the lead. QUESTIONER Right. And that's it's like they saw this piece of paper that's a bunch of questions, essentially gauging their fear of injury or fear of re injury, you know, because you could I've had people that have been physically 100% good to go pass all these tests.
01:53:51:08 - 01:54:13:21
Speaker 1
I threw everything I could possibly think at these people, and they just don't have it for yet. It's not ready to go. They're mentally not there. Right. And that's somebody that okay, what's let's stick to the plan then. Let's get back in the gym. Let's take a little slower, X, Y, Z. Right. And that little bit of confidence, I think, can really it can put people at a risk of or lack of confidence, I should say, can put people of risk of injury.
01:54:13:21 - 01:54:34:04
Speaker 1
You know, like, like for a good example is like six or eight years ago. Derrick Rose is baseball player, stud basketball player. In the NBA, there's ACL rehabs all year that he's on the Bulls. Right. Bulls are good in the playoffs. He's starting to finish up his rehab, his return to sports stuff. He's passing everything. He just refused to get back in the game.
01:54:34:12 - 01:54:53:09
Speaker 1
He said, I can't do it. I'm not mentally ready. I'm too fearful of re injury. They held him out. Of course, all the Bulls fans are pissed, right? But he comes back in summer league terrorism. Right. So he still wasn't quite. I mean, accidents happen. Don't get me wrong. You could either you could have somebody perfectly that have zero fear and still reinjured themselves.
01:54:53:16 - 01:55:05:19
Speaker 1
But you kind of wonder if in that case, you know, not having the confidence be a little nervous, being scared, you know, playing hesitantly can all contribute to your risk of injury and not being ready to go back completely.
01:55:07:00 - 01:55:08:23
Speaker 3
There's a level of having an intuition.
01:55:09:00 - 01:55:19:13
Speaker 1
Mm hmm. Yeah, yeah, absolutely yeah, yeah. Just your own. You got to reflect yourself, you know, and say, okay, physically, the. The says, I'm good, but am I. Am I good? You know, let me be honest with me.
01:55:19:13 - 01:55:41:18
Speaker 4
Yeah. You know, there was a study I was exposed to in graduate school where orthopedic surgeons looked at traumatic knee injury and football players and they used fantasy football scores. And what they saw, you know, the clear they go through everything that player gear one produced about 50% of the fantasy points that he produced the year before his injury.
01:55:42:02 - 01:56:18:01
Speaker 4
And then by a year or two, he was back to normal production. And so that's something I also sort of reiterate with my patients is that even professional athletes, they may not perform to where they were before, but they eventually get back there. And these circles back all the way to that bio psychosocial aspect, like all of these intertwined belief structures, you know, anatomy, structure structures, everything comes together and it does add this really sort of complex return to sport and recovery aspect that has to be examined a little bit more depth by the patient.
01:56:19:15 - 01:56:24:20
Speaker 1
Awesome guys. I think that's that's a perfect place to end it if you guys are. Okay. Kyle, did you have anything else?
01:56:25:21 - 01:56:48:10
Speaker 4
Yeah, I have one more thing. One more thing for the listeners out there. This is I live my professional life by this is real simple. It's like we'll wrap up in applause, I guess afterwards. But I do believe this. I think movement can replace medicine. Right. We understand that. But medicine, medicine can never replace movement. So just like get out there and do these things.
01:56:48:16 - 01:56:52:21
Speaker 4
And I think that's probably my last sort of thing for the listeners.
01:56:53:13 - 01:56:56:13
Speaker 1
Yeah Awesome. Kevin, Matthew.
01:56:57:05 - 01:56:58:03
Speaker 3
Thanks so much.
01:56:58:10 - 01:57:04:05
Speaker 1
For coming on and it's been a pleasure talking with you and stuff. And you know, who knows? Maybe we can have the conversation in the future.
01:57:05:18 - 01:57:06:14
Speaker 4
Keep us in mind.
01:57:07:02 - 01:57:13:06
Speaker 1
Yeah, thanks for having us. It was a lot of fun and good luck to both your guys's recovery and and getting back. Good luck with the house.
01:57:13:06 - 01:57:16:08
Speaker 3
And the kids. My friend.
01:57:16:08 - 01:57:17:14
Speaker 2
Yeah. Yeah. Appreciate it.
01:57:20:16 - 01:57:25:00
Speaker 4
Thank you again, Kyle, for reaching out. And I appreciate this opportunity. And Kevin, thanks for joining us.
01:57:25:02 - 01:57:27:11
Speaker 1
Yeah, yeah. Nice meeting you guys as well, then.
01:57:27:21 - 01:57:28:15
Speaker 3
Yeah, definitely.
01:57:29:00 - 01:57:29:23
Speaker 4
Max, nice to meet you.
01:57:30:07 - 01:57:56:16
Speaker 1
Take care. I.